Intravascular stenting of acute experimental type B dissections.
Intravascular stenting of acute experimental type B dissections.
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急性实验性 B 型夹层的血管内支架置入术。
DOI：
10.1006/jsre.1993.1061
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Miller,DC
中科院分区：
文献类型：
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作者：
Moon,MR;Dake,MD;Pelc,LR;Liddell,R;Castro,LJ;Mitchell,RS;Miller,DC
为评价血管内支架置入术治疗急性主动脉夹层的疗效，对12只犬进行了急性B型夹层的外科手术。血管内超声评估管腔直径、远端传播和分支受累。三只动物没有接受进一步的治疗(对照)。9只犬放置球囊扩张血管内支架(15~20 mm)近端压迫内膜瓣。一只小夹层的狗在最初的支架放置后，假腔完全消失。6只横隔膜以下延伸的狗最初在近端放置支架以恢复血流；3只留下残留的远端假腔，3只额外放置支架以消除整个假腔。在最后2只狗中，近端支架植入仅导致假腔的部分压缩。两只动物在24小时内分别死于血流动力学不稳定和主动脉内膜瓣破裂。6周后，对10只存活的动物进行放射学和组织学评价。所有支架内的真腔通畅，无血栓形成，支架被新生内膜覆盖。在对整个夹层进行支架植入的狗中，主动脉壁已经愈合，没有假腔存在。然而，在所有只有近端闭塞、1/2部分受压和2/3对照组的狗中，存在明显的假通道，表明存在慢性夹层。因此，我们发现，在实验性夹层中，血管内支架可以恢复真实的管腔血流并消除假腔；然而，仅限于近端夹层的支架并不能防止长期残留的未闭假腔的形成。
To evaluate the efficacy of intravascular stenting for acute aortic dissection, 12 dogs underwent surgical creation of an acute type B dissection. Intravascular ultrasound evaluated luminal diameter, distal propagation, and branch involvement. Three animals underwent no further treatment (control). In 9 dogs, balloon-expandable intravascular stents (15-20 mm) were placed proximally to compress the intimal flap. One dog with a small dissection had complete obliteration of the false lumen after initial stent placement. Six dogs with extension below the diaphragm were initially stented proximally to restore flow; 3 were left with a residual distal false lumen, while 3 had additional stents placed to obliterate their entire false lumen. In the final 2 dogs, proximal stenting resulted only in partial compression of the false lumen. Two animals died within 24 hr due to prolonged hemodynamic instability and aortic rupture at the intimal flap, respectively. Six weeks later, radiologic and histologic evaluation was performed on the 10 surviving animals. All stented true lumens were patent without thrombus formation, and stents were covered by neointima. In dogs with stenting of the entire dissection, the aortic wall had healed and no false lumen was present. However, in all dogs with only proximal obliteration, 1/2 with partial compression, and 2/3 controls, a patent false channel was present indicative of a chronic dissection. Thus, we found that intravascular stents can restore true lumen flow and obliterate the false lumen in experimental dissections; however, stenting limited to the proximal dissection does not prevent formation of a chronic residual patent false lumen.