Stefanov Florian, Sultan Sherif, Morris Liam, Elhelali Ala, Kavanagh Edel P, Lundon Violet, Sultan Mohamed, Hynes Niamh
Department of Mechanical and Industrial Engineering, Galway Medical Technologies Centre (GMedTech), Galway Mayo Institute of Technology, Galway, Ireland.
Department of Vascular and Endovascular Surgery, Galway Clinic, Galway, Ireland; Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland; National University of Ireland, Galway, Ireland.
J Vasc Surg. 2017 Apr;65(4):951-963. doi: 10.1016/j.jvs.2016.07.135. Epub 2016 Nov 23.
Managing symptomatic chronic type B aortic dissection (SCTBAD) by the Streamliner Multilayer Flow Modulator (SMFM) stent (Cardiatis, Isnes, Belgium) is akin to provisional structural support to induce complete attachment of the dissection flap, but with the ability of aortic remolding. This study investigated the SMFM's capability to enact healing of SCTBAD.
Clinical data for 12 cases comprising preoperative and postoperative treatment of SCTBAD were obtained from a multicenter database hosted by the Multilayer Flow Modulator Global Registry, Ireland. A biomechanical analysis, by means of computational fluid dynamics modeling, of the hemodynamic effects and branch patency associated with the use of the SMFM was performed for all cases. The mean length of the dissections was 30.23 ± 13.3 cm. There were 30 SMFMs used, which covered 69 aortic branches.
At 1-year follow-up, the true lumen volume increased from 175.74 ± 98.83 cm to 209.87 ± 128.79 cm; the false lumen decreased from 135.2 ± 92.03 cm to 123.19 ± 110.11 cm. The false lumen index decreased from 0.29 ± 0.13 (preoperatively) to 0.21 ± 0.15 (postoperatively). The primary SMFM treatment of SCTBAD increased carotid perfusion by 35% ± 21% (P = .0216) and suprarenal perfusion by 78% ± 32% (P = .001). The wall pressure distribution blended along the newly enlarged true lumen, whereas the false lumen wall pressure decreased by 6.23% ± 4.81% for the primary group (cases 1-7) and by 3.84% ± 2.59% for the secondary group (cases 8-12).
SMFM reduces the false lumen wall pressure through flow modulation. It preserves patency of all branches, minimizing the incidence of short-term complications. The SMFM is a valuable option in managing primary SCTBAD, without midterm complications.
使用Streamliner多层血流调节器（SMFM）支架（Cardiatis公司，比利时伊斯内斯）治疗有症状的慢性B型主动脉夹层（SCTBAD）类似于提供临时结构支撑以促使夹层瓣完全附着，但具有主动脉重塑的能力。本研究调查了SMFM实现SCTBAD愈合的能力。
从爱尔兰多层血流调节器全球注册中心主办的多中心数据库中获取12例SCTBAD术前和术后治疗的临床数据。对所有病例进行了基于计算流体动力学建模的生物力学分析，以评估使用SMFM后的血流动力学效应和分支通畅情况。夹层的平均长度为30.23±13.3厘米。共使用了30个SMFM，覆盖69个主动脉分支。
在1年随访时，真腔容积从175.74±98.83立方厘米增加到209.87±128.79立方厘米；假腔从135.2±92.03立方厘米减少到123.19±110.11立方厘米。假腔指数从术前的0.29±0.13降至术后的0.21±0.15。SCTBAD的初次SMFM治疗使颈动脉灌注增加35%±21%（P = 0.0216），肾上腺灌注增加78%±32%（P = 0.001）。壁压力分布沿新扩大的真腔融合，而假腔壁压力在初次治疗组（病例1 - 7）降低了6.23%±4.81%，在二次治疗组（病例8 - 12）降低了3.84%±2.59%。
SMFM通过血流调节降低假腔壁压力。它能保持所有分支的通畅，将短期并发症的发生率降至最低。SMFM是治疗原发性SCTBAD且无中期并发症的一种有价值的选择。
