Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Vasc Surg. 2013 May;57(5):1311-6. doi: 10.1016/j.jvs.2012.10.110. Epub 2013 Jan 26.
The primary purpose of the current study was to evaluate the safety and effectiveness of selective coverage of the left subclavian artery (LSCA) without revascularization during thoracic endovascular aortic repair (TEVAR) in patients with bilateral patent vertebrobasilar junctions. The secondary purpose was to assess morphologic change of the vertebral artery (VA) after the procedure.
Among 126 patients who underwent TEVAR between 2006 and 2011, 29 patients requiring LSCA coverage without preemptive revascularization were retrospectively analyzed in this study. The patients were a mean age of 63.1 years (range, 45-84 years). The mean follow-up period was 19.9 months (range, 1-63 months). Bilateral patent vertebrobasilar junctions were evaluated by contrast-enhanced computed tomography (CT), time-of flight magnetic resonance angiography, or conventional angiography. Neurologic complications, such as spinal cord ischemia (SCI) or cerebrovascular accidents, were analyzed. Preprocedural and postprocedural changes in VAs were evaluated on follow-up contrast-enhanced CT.
The overall 30-day mortality was 6.9% (2 of 29). None of the patients had SCI or a stroke of posterior circulation alone. Cerebrovascular accidents from embolic infarctions occurred in two patients (7.4%). Transient left arm ischemic symptoms were present in five patients (18.5%), but none required secondary interventions. Delayed development of type I endoleak occurred due to stent deformity in one patient, who underwent surgery. One patient required reintervention after the 10-month follow-up contrast-enhanced CT showed a pseudoaneurysm had developed at the distal margin of the previously placed stent graft. Hypertrophy of the right VA after TEVAR was seen in seven of 27 patients (25.9%); two patients showed bilateral hypertrophy of VAs.
LSCA coverage without revascularization can be safely performed during TEVAR in patients with bilateral patent vertebrobasilar junctions. Hypertrophy of the right VA was noted in 25.9% of patients after LSCA coverage.
本研究的主要目的是评估在双侧椎动脉基底动脉交界通畅的患者中行胸主动脉腔内修复术（TEVAR）时，选择性覆盖而非重建左锁骨下动脉（LSCA）的安全性和有效性。次要目的是评估术后椎动脉（VA）形态学的变化。
在 2006 年至 2011 年间接受 TEVAR 的 126 例患者中，回顾性分析了 29 例需要 LSCA 覆盖而无需预先血管重建的患者。患者的平均年龄为 63.1 岁（范围，45-84 岁）。平均随访时间为 19.9 个月（范围，1-63 个月）。双侧椎动脉基底动脉交界通畅通过增强 CT、时间飞跃磁共振血管造影或常规血管造影评估。分析脊髓缺血（SCI）或脑血管意外等神经并发症。在随访增强 CT 上评估 VA 的术前和术后变化。
总的 30 天死亡率为 6.9%（29 例中的 2 例）。无患者发生 SCI 或单纯后循环卒中。2 例（7.4%）发生栓塞性梗死引起的脑血管意外。5 例（18.5%）出现短暂左上肢缺血症状，但均无需二次干预。1 例因支架变形导致Ⅰ型内漏发生，行手术治疗。1 例患者在 10 个月的随访增强 CT 后发现原支架移植物远端边缘出现假性动脉瘤，需要再次干预。27 例患者中有 7 例（25.9%）在 TEVAR 后出现右 VA 肥大；2 例患者出现双侧 VA 肥大。
在双侧椎动脉基底动脉交界通畅的患者中行 TEVAR 时，可以安全地进行 LSCA 覆盖而无需重建。LSCA 覆盖后，25.9%的患者右 VA 出现肥大。
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