Cardiac Surgery Department, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, Szczecin 72-111, Poland.
Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, Szczecin 72-111, Poland.
Rev Cardiovasc Med. 2020 Mar 30;21(1):129-137. doi: 10.31083/j.rcm.2020.01.5105.
There have been indisputable developments in techniques for stabilizing acute aortic syndromes. However, aneurysmal degeneration following aortic dissection remains a problem to be solved. The currently available treatment options for aortic dissection still fail to take into account the known risk factors for aneurysmal degeneration. This is why we introduced a new approach to treating patients with an aortic dissection, called Complete Entry and Re-entry Neutralization (CERN). This is our initial report on the promising interim results.
68 patients qualified for endovascular treatment of an acute or chronic aortic dissection. Computed tomography was performed post-operatively to assess aortic remodeling after 1/6/12/24/36 months.
the 30-day mortality rate was 4.4%. In 29 cases (43%) unfavorable remodeling was noted in the follow-up. The most important factors leading to unfavorable remodeling were: uncovered re-entry tear including the infra-renal segment, no relining of dissection membranes and insufficient coverage of the descending aorta. We analyzed these factors to develop the CERN protocol. This concept consists of six basic rules: A. cover all entry tears, B. amplify the BMS radial force, C. use the STABILISE technique, D. consider using thrombus plugs, E. avoid stenting the visceral branches, F. spare the intercostal and lumbar side branches. CERN improves the rate of favorable remodeling from 25% to 85% ( = 0.0067).
Introduction of the Complete Entry and Re-entry Neutralization protocol improves the rate of favorable remodeling following endovascular treatment of aortic dissection in mid-term follow-up in patients with diffused aortic dissection.
在稳定急性主动脉综合征的技术方面已经取得了无可争议的进展。然而，主动脉夹层后的动脉瘤退行性变仍然是一个待解决的问题。目前可用于治疗主动脉夹层的治疗选择仍然没有考虑到已知的动脉瘤退行性变的风险因素。这就是为什么我们引入了一种治疗主动脉夹层患者的新方法，称为完全入口和再入口中和（CERN）。这是我们关于有希望的中期结果的初步报告。
68 名患者符合急性或慢性主动脉夹层的血管内治疗标准。术后进行计算机断层扫描，以评估术后 1/6/12/24/36 个月的主动脉重塑情况。
30 天死亡率为 4.4%。在 29 例（43%）患者中，在随访中观察到不良重塑。导致不良重塑的最重要因素是：未覆盖再入口撕裂，包括肾下节段，夹层膜未再衬里和降主动脉覆盖不足。我们分析了这些因素，以制定 CERN 方案。该概念由六个基本规则组成：A. 覆盖所有入口撕裂，B. 增强 BMS 径向力，C. 使用 STABILISE 技术，D. 考虑使用血栓塞，E. 避免支架内脏分支，F. 保留肋间和腰侧分支。CERN 将有利重塑率从 25%提高到 85%（=0.0067）。
在中期随访中，引入完全入口和再入口中和方案可提高弥漫性主动脉夹层患者血管内治疗后有利重塑率。
