1 Division of Cardiovascular Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
J Endovasc Ther. 2014 Apr;21(2):306-11. doi: 10.1583/13-4439MR.1.
To report a challenging carotid intervention after total arch rerouting and hybrid zone 0 elephant trunk repair.
A 54-year-old man developed symptomatic left carotid artery restenosis 2 weeks after total arch rerouting and hybrid zone 0 elephant trunk repair for acute retrograde type A aortic dissection with left carotid malperfusion. Because the origins of the 3 supra-aortic branches were already transected and rerouted to the proximal end of the reconstructed ascending aortic graft, the peripheral access routes for carotid intervention were deemed difficult, with little chance of success due to acute angles between these rerouted supra-aortic branches and the ascending aortic graft. Emergent carotid artery stenting was therefore performed via sternal reentry with successful restoration of cerebral perfusion.
Total arch rerouting, facilitating hybrid endovascular repair for extensive thoracic aortic disease, creates an extremely deformed arch anatomy that renders subsequent carotid intervention a challenging task.
报告 1 例全弓重建和杂交零区象鼻手术后颈动脉介入治疗的挑战性病例。
1 名 54 岁男性，因急性逆行性 A 型主动脉夹层伴左侧颈动脉灌注不良，在全弓重建和杂交零区象鼻手术后 2 周时出现症状性左侧颈动脉再狭窄。由于 3 个升主动脉分支的起点已被横断并重新吻合至重建的升主动脉移植物的近端，因此颈动脉介入治疗的外周入路被认为较为困难，由于这些重新吻合的升主动脉分支与升主动脉移植物之间存在锐角，成功的机会很小。因此，通过胸骨再入路紧急进行颈动脉支架置入术，成功恢复了脑灌注。
全弓重建促进了广泛的胸主动脉疾病的杂交血管内修复，形成了极其变形的主动脉弓解剖结构，使得随后的颈动脉介入治疗成为一项具有挑战性的任务。
