Clinical Application of a Curved Nitinol Stent-Graft for Thoracic Aortic Aneurysms
Clinical Application of a Curved Nitinol Stent-Graft for Thoracic Aortic Aneurysms
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弯曲镍钛合金覆膜支架治疗胸主动脉瘤的临床应用
DOI：
10.1177/152660280301000106
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
M. Endo
中科院分区：
文献类型：
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作者：
J. Sanada;O. Matsui;N. Terayama;Satoshi Kobayashi;T. Minami;M. Kurozumi;H. Ohtake;H. Urayama;M. Endo
目的：评价弯曲镍钛诺支架修复胸主动脉瘤的临床疗效。方法：对11例（6例男性，平均年龄72.6岁，33-90岁）主动脉远端弓或降主动脉近端有6个真动脉瘤和5个假动脉瘤的患者，采用自膨胀镍钛诺支架和聚酯纤维组成的Matsui-Kitamura支架-graft （MKSG）。发射系统是18或20-F j型护套与预装药型引信相结合。最初的平均颈近端长度为16.4 mm，但有4例患者接受了腋窝旁路术以延长颈部。虽然平均校正后的近端颈部长度为21.9 mm（总体），但仍有5例近端颈部长度<15 mm。结果：所有弯曲的MKSGs都成功部署在正确的位置，并与主动脉弓的弯曲相吻合，8例（73%）患者实现了完全的动脉瘤排除。其余3处修复处出现早期渗漏；1个接受了额外的MKSG，但其他2个正在观察中。30天死亡率为0%。1例患者出现一过性肾功能衰竭，需要血液透析；未见神经系统并发症。结论：采用弯曲型MKSGs进行胸主动脉瘤血管内修复是可行且有效的。尽管近端颈部较短，但该装置与主动脉弓弯曲的更紧密配合可以排除远端弓动脉瘤。
Purpose: To evaluate the clinical efficacy of a curved nitinol stent-graft for repair of thoracic aortic aneurysms. Methods: The Matsui-Kitamura stent-graft (MKSG), composed of a self-expanding nitinol stent and polyester fabric, was shaped to match the aortic curvature of 11 patients (6 men; mean age 72.6 years, range 33–90) with 6 true and 5 false aneurysms of the distal arch or proximal descending aorta. The delivery system was an 18 or 20-F J-shaped sheath combined with a preloader-type introducer. The original mean proximal neck length was 16.4 mm, but 4 patients received an axilloaxillary bypass to lengthen the neck. Although the mean corrected proximal neck length was 21.9 mm (overall), 5 cases still had proximal necks <15 mm long. Results: All curved MKSGs were successfully deployed in the correct position and fitted to the curvature of the aortic arch, achieving complete aneurysm exclusion in 8 (73%) cases. The other 3 repairs displayed early endoleaks; 1 received an additional MKSG, but the other 2 are being observed. Thirty-day mortality was 0%. One patient developed transient renal failure requiring hemodialysis; no neurological complications were observed. Conclusions: Endovascular repair of thoracic aortic aneurysms using curved MKSGs appears to be feasible and clinically effective. A tighter fit of the device to the curvature of the aortic arch may exclude distal arch aneurysms despite a short proximal neck.