Antonello Michele, Squizzato Francesco, Dall'Antonia Alberto, Grego Franco, Piazza Michele
Vascular and Endovascular Surgery Division, Padua University - School of Medicine, Padua, Italy.
Vascular and Endovascular Surgery Division, Padua University - School of Medicine, Padua, Italy.
Ann Vasc Surg. 2019 Jul;58:261-269. doi: 10.1016/j.avsg.2018.11.020. Epub 2019 Feb 13.
The aim was to describe a single-center experience with the Conformable GORE TAG Thoracic Endoprosthesis (C-TAG) with active control system, specifically designed to evaluate the accuracy of proximal and distal deployment and its capability to adapt to the aortic wall.
This is a single-center prospective study including all patients treated with the C-TAG with active control system for thoracic aorta pathologies from September 2017 to May 2018. Proximal and distal accuracy of deployment was measured as the distance between "intended" and "actual landing" zone measured on the digital subtraction angiography images. Mean lack of wall apposition was measured at postoperative computed tomography (CT) angiogram images as the distance between the proximal or distal graft radiopaque ring marker and the point of graft aortic complete apposition, using parasagittal multiplanar reconstructions.
Eleven cases were treated: 6 atherosclerotic aneurysms (5 descending and 1 arch), 1 dissecting aneurysm, 2 type B acute dissections, 1 thoracic pseudoaneurysm, and 1 Kommerell diverticulum. The proximal deployment was in landing zone 3 in 6 cases (54%), 2 in 2 cases (18%), 1 in 1 case (9%), and 0 in 2 (18%). The distal landing was in zone 4 in 1 case (9%), zone 5 in 9 cases (81%), and in 1 case (9%), it was in zone 6 with intentional coverage of the celiac trunk. Rapid pacing was used only in 2 cases. Mean accuracy of deployment was 1.8 ± 1.3 mm for the proximal and 0.7 ± 1 mm for the distal landing zones. Mean lack of wall apposition was 1.1 ± 1.9 mm at the proximal landing zone and 0.6 ± 1.8 mm at the distal landing zone.
The C-TAG with active control system offers accurate deployment both at the proximal and at the distal levels. The conformability, staged deployment, and angulation control allow good adaptation to aortic arch and precise deployment.
目的是描述使用带有主动控制系统的适形戈尔TAG胸段内支架（C-TAG）的单中心经验，该系统专门设计用于评估近端和远端展开的准确性及其适应主动脉壁的能力。
这是一项单中心前瞻性研究，纳入了2017年9月至2018年5月期间所有使用带有主动控制系统的C-TAG治疗胸主动脉病变的患者。展开的近端和远端准确性通过在数字减影血管造影图像上测量“预期”和“实际着陆”区域之间的距离来评估。术后计算机断层扫描（CT）血管造影图像上，使用矢状旁多平面重建测量近端或远端移植物不透射线环标记与移植物与主动脉完全贴合点之间的距离，以此来评估平均壁贴合不足情况。
共治疗11例患者：6例动脉粥样硬化性动脉瘤（5例降主动脉和1例主动脉弓）、1例夹层动脉瘤、2例B型急性夹层、1例胸段假性动脉瘤和1例Kommerell憩室。近端展开在着陆区3的有6例（54%），在着陆区2的有2例（18%），在着陆区1的有1例（9%），在着陆区0的有2例（18%）。远端着陆在区域4的有1例（9%），在区域5的有9例（81%），在区域6且有意覆盖腹腔干的有1例（9%）。仅2例使用了快速起搏。近端着陆区展开的平均准确性为1.8±1.3毫米，远端着陆区为0.7±1毫米。近端着陆区平均壁贴合不足为1.1±1.9毫米，远端着陆区为0.6±1.8毫米。
带有主动控制系统的C-TAG在近端和远端水平均能实现准确展开。其顺应性、分期展开和角度控制使其能够很好地适应主动脉弓并实现精确展开。
