Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 650, Chicago, IL 60611, USA.
J Vasc Interv Radiol. 2010 Sep;21(9):1364-9. doi: 10.1016/j.jvir.2010.04.028. Epub 2010 Aug 5.
Percutaneous catheter-based treatment of supraaortic trunk arterial occlusive lesions obviates the need for extraanatomic bypass or median sternotomy. Although early results have been encouraging, late outcomes have yet to be defined. Reported are long-term outcomes of supraaortic trunk stent placement with particular attention to structural failures.
This was a retrospective review of 27 ostial supraaortic trunk lesions managed with balloon-expandable or self-expandable stents. Treated vessels were innominate (n = 9), common carotid (n = 8), and subclavian (n = 10). Access to the target lesion was achieved either antegrade via the femoral artery (n = 13), retrograde through the brachial artery (n = 2), or through a cutdown on the common carotid artery (n = 12). Restenosis and stent integrity were detected with duplex imaging, computed tomography, conventional arteriography, and plain radiography. Mean follow-up time is 34 months.
Mean age was 68 years (eight men and 19 women), and mean stenosis was 85%. Preprocedural symptoms, including stroke, transient ischemic attack, arm fatigue, digital ischemia, and angina were present in 85% (23 of 27) of the group. At 30 days, there were no deaths, myocardial infarctions, or strokes. During follow-up, three type IV stent fractures in the innominate were detected as well as two midbody stent crush deformities with significant restenosis (one innominate and one common carotid). All stent failures were identified in heavily calcified lesions.
Endoluminal stent placement in supraaortic trunk lesions is a viable early solution; however, mid- to long-term restenosis caused by bare metal fatigue and fractures, particularly in cases of calcified innominate artery lesions, are a worrisome finding.
经皮导管治疗主动脉弓上动脉阻塞性病变，避免了需要进行外旁路或正中开胸手术。尽管早期结果令人鼓舞，但晚期结果尚未确定。本文报告了主动脉弓支架置入术的长期结果，特别关注结构失败。
这是一项对 27 例主动脉弓起始部病变进行球囊扩张或自膨式支架治疗的回顾性研究。治疗的血管为无名动脉（n=9）、颈总动脉（n=8）和锁骨下动脉（n=10）。通过股动脉（n=13）、肱动脉（n=2）或颈总动脉切开（n=12）顺行或逆行入路到达靶病变。使用双功能超声、计算机断层扫描、常规血管造影和普通 X 线检查检测再狭窄和支架完整性。平均随访时间为 34 个月。
平均年龄为 68 岁（8 名男性和 19 名女性），平均狭窄率为 85%。85%（23/27）的患者术前有症状，包括中风、短暂性脑缺血发作、手臂疲劳、手指缺血和心绞痛。30 天内无死亡、心肌梗死或中风。在随访期间，发现 3 例无名动脉支架 IV 型骨折，2 例中体支架压碎变形伴明显再狭窄（1 例无名动脉，1 例颈总动脉）。所有支架失效均发生在严重钙化病变中。
主动脉弓上病变腔内支架置入术是一种可行的早期治疗方法；然而，裸金属疲劳和骨折导致的中至长期再狭窄，特别是在钙化的无名动脉病变中，是一个令人担忧的发现。
