Cardaioli Paolo, Rigatelli Gianluca, Giordan Massimo, Faggian Giuseppe, Chinaglia Mauro, Roncon Loris
Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Italy.
Cardiovasc Revasc Med. 2007 Jul-Sep;8(3):213-5. doi: 10.1016/j.carrev.2006.09.004.
Acute aortic dissection is one of the most common catastrophes affecting the aorta. Aortic branch occlusion occurs in up to one third of patients with aortic dissection and is associated with increased risk for early death and serious complications. A 67-year-old man without history of cardiovascular disease was referred to our center for acute aortic type A dissection and was treated with a 28-mm Vasculteck prosthesis. During the early postoperative period, he felt left hemiparesis, and an angio-computed tomography showed a progression of the dissection to the right common carotid artery and left brachiocephalic trunk: the abdominal aorta with the celiac trunk. We felt that the patient should receive conservative management, except for the carotid involvement, for which an endovascular approach was planned. After carefully engaging the carotid ostia with a modified no-touch technique, a self-expandable stent and a balloon-expandable stent were deployed to seal the left common and internal carotid artery dissection, whereas two self-expandable stents were implanted within the right internal carotid artery. Angiographic control demonstrated complete sealing of the carotid dissections. The patient recovered quickly after the intervention and was discharged after 2 days without any neurologic or vascular complication. The patient did extremely well at two 3-month follow-ups, and coverage of the descending thoracic aorta dissection was scheduled to be performed in the next 2 months. This case suggests that endovascular techniques may offer a reliable and effective answer to extended dissections, helping decrease the risk for neurologic or visceral complications and reducing the operative risk for further complete surgical or endovascular aortic repair.
急性主动脉夹层是影响主动脉的最常见灾难性疾病之一。高达三分之一的主动脉夹层患者会发生主动脉分支闭塞，这与早期死亡和严重并发症的风险增加有关。一名无心血管疾病史的67岁男性因急性A型主动脉夹层被转诊至我们中心，并接受了一枚28毫米的Vasculteck人工血管治疗。术后早期，他出现左侧偏瘫，血管计算机断层扫描显示夹层进展至右侧颈总动脉和左侧头臂干：包括腹腔干的腹主动脉。我们认为，除颈动脉受累外，该患者应接受保守治疗，针对颈动脉受累计划采用血管内治疗方法。在采用改良的非接触技术小心地进入颈动脉开口后，置入了一枚自膨式支架和一枚球囊扩张式支架以封闭左侧颈总动脉和颈内动脉夹层，同时在右侧颈内动脉内植入了两枚自膨式支架。血管造影检查显示颈动脉夹层完全封闭。干预后患者恢复迅速，2天后出院，无任何神经或血管并发症。在两次3个月的随访中，患者情况极佳，计划在接下来的2个月内对降主动脉夹层进行覆膜治疗。该病例表明，血管内技术可能为广泛夹层提供可靠有效的治疗方法，有助于降低神经或内脏并发症的风险，并降低进一步进行完全手术或血管内主动脉修复的手术风险。
