Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara, Sakyo, Kyoto 606-8507, Japan.
J Thorac Cardiovasc Surg. 2010 Mar;139(3):655-9. doi: 10.1016/j.jtcvs.2009.05.006. Epub 2009 Dec 8.
Paraplegia remains a serious complication after endovascular repair of thoracic aortic aneurysms, and it has been reported that paraplegia might be due to ischemia of the artery of Adamkiewicz. This study investigates the feasibility of an Inoue stent graft with a side branch of a small caliber for the reconstruction of the intercostal artery branching the artery of Adamkiewicz.
Branched Inoue stent grafts were implanted into the thoracic aorta and 11th intercostal artery of 5 mongrel dogs. The side branch measured 3 x 5 mm and contained a bare-metal coronary stent for fixing to the intercostal arterial wall. Aortography and selective angiography of the 11th intercostal artery were performed before and immediately after implantation and after 1, 4, 8, and 12 weeks. The luminal diameter of the intercostal artery before implantation was 2.4 +/- 0.3 mm.
All stent grafts were successfully deployed. The main body of the graft did not develop endoleak or migrate, and the side branch remained patent for 12 weeks. Angiography performed 1 week postoperatively revealed smooth flow with slight stenosis (4.2% +/- 1.7%) along the side branches and the intercostal arteries in all dogs. Four weeks postoperatively, however, mild concentric stenosis (38% +/- 16%) along the side branch was observed in 4 of the 5 dogs. The percent stenosis at 8 and 12 weeks was 38% +/- 15% and 33% +/- 11%, respectively; these values were not significantly different from the value at 4 postoperative weeks.
A novel Inoue stent graft with a side branch of small caliber was successfully deployed into the canine thoracic aorta and intercostal artery; the side branch remained patent for 12 weeks. This novel technique may enable endovascular reconstruction of the Adamkiewicz artery.
胸主动脉瘤血管内修复后仍会发生截瘫等严重并发症，有报道称截瘫可能是由于 Adamkiewicz 动脉缺血所致。本研究探讨采用小口径分支的 Inoue 覆膜支架重建供应 Adamkiewicz 动脉的肋间动脉的可行性。
将分支型 Inoue 覆膜支架植入 5 只杂种犬的胸主动脉和第 11 肋间动脉。侧支长 3 x 5mm，包含一个裸金属冠状动脉支架，用于固定在肋间动脉壁上。在植入前、植入后即刻以及植入后 1、4、8 和 12 周进行主动脉造影和第 11 肋间动脉选择性血管造影。植入前肋间动脉的管腔直径为 2.4 +/- 0.3mm。
所有支架均成功植入。移植物主体未发生内漏或移位，侧支在 12 周内保持通畅。术后 1 周血管造影显示，所有犬的侧支和肋间动脉均有轻微狭窄（4.2% +/- 1.7%），血流通畅。然而，术后 4 周，5 只犬中有 4 只侧支出现轻度同心性狭窄（38% +/- 16%）。8 周和 12 周时的狭窄率分别为 38% +/- 15%和 33% +/- 11%，与术后 4 周时无显著差异。
新型小口径分支型 Inoue 覆膜支架成功植入犬胸主动脉和肋间动脉，侧支通畅 12 周。该新技术可能实现对供应 Adamkiewicz 动脉的血管内重建。
