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孤立性肠系膜动脉夹层的血管内治疗:单纯使用裸支架与支架辅助弹簧圈治疗的对比。

Endovascular treatment of systematic isolated mesenteric artery dissection with a patent false lumen: Bare stents alone versus stent-assisted coiling.

机构信息

Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

出版信息

Sci Prog. 2023 Oct-Dec;106(4):368504231214959. doi: 10.1177/00368504231214959.

Abstract

OBJECTIVES

Bare stent treatment and bare stent-assisted coiling treatment have not been directly compared in symptomatic isolated superior mesenteric artery dissection with a patent false lumen. Thus, we compared the early and mid-term outcomes of bare stent treatment and bare stent-assisted coiling treatment to determine the most effective remedy for patients with this condition.

METHODS

Consecutive patients diagnosed with systematic isolated superior mesenteric artery dissection with a patent false lumen admitted to the study hospital between January 2016 and December 2021 were enrolled in this retrospective study. Their demographic data, clinical findings, treatment options, early outcomes, and follow-up results were analyzed.

RESULTS

A total of 85 patients (83 men) were included. 34.1% (n = 29) adopted bare stent treatment and 65.9% (n = 56) underwent bare stent-assisted coiling treatment. The symptoms were relieved in all patients (100%) with bare stent treatment and bare stent-assisted coiling treatment. There was no significant difference in the length of hospital stay between the two endovascular treatments ( = 0.354). The cumulative complete remodeling rate was 100% in bare stent-assisted coiling treatment vs. 70.4% in bare stent treatment ( < 0.0001). The prevalence of adverse events for abdominal pain recurrence (none in BST or bare stent-assisted coiling treatment), and formation of the aneurysm (two in bare stent treatment, and none in bare stent-assisted coiling treatment) showed no significant difference at follow-up.

CONCLUSION

Both bare stent treatment and bare stent-assisted coiling treatment for symptomatic isolated superior mesenteric artery dissection with a patent false lumen have the same satisfying early outcome. In the midterm follow-up, bare stent-assisted coiling treatment has the higher cumulative complete remodeling rate which could be prioritized to treat this condition.

摘要

目的

对于有通畅假腔的症状性孤立性肠系膜上动脉夹层,裸支架治疗和裸支架辅助弹簧圈治疗尚未进行直接比较。因此,我们比较了裸支架治疗和裸支架辅助弹簧圈治疗的早期和中期结果,以确定对这种情况最有效的治疗方法。

方法

回顾性分析 2016 年 1 月至 2021 年 12 月期间在研究医院住院的诊断为系统性孤立性肠系膜上动脉夹层且假腔通畅的连续患者。分析其人口统计学数据、临床发现、治疗选择、早期结果和随访结果。

结果

共纳入 85 例患者(83 例男性)。34.1%(n=29)采用裸支架治疗,65.9%(n=56)采用裸支架辅助弹簧圈治疗。裸支架治疗和裸支架辅助弹簧圈治疗的所有患者(100%)症状均得到缓解。两种血管内治疗的住院时间无显著差异(t=0.354)。裸支架辅助弹簧圈治疗的完全再塑形累积率为 100%,而裸支架治疗的为 70.4%(P<0.0001)。随访时,腹痛复发(裸支架或裸支架辅助弹簧圈治疗均无)和动脉瘤形成(裸支架治疗 2 例,裸支架辅助弹簧圈治疗无)的不良事件发生率无显著差异。

结论

对于有通畅假腔的症状性孤立性肠系膜上动脉夹层,裸支架治疗和裸支架辅助弹簧圈治疗均有满意的早期效果。在中期随访中,裸支架辅助弹簧圈治疗的完全再塑形累积率更高,可优先用于治疗这种疾病。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/35f9/10664444/5a9a2acf40e6/10.1177_00368504231214959-fig1.jpg

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