Lemmens Charlotte C, Konings Tom J A J, Dean Anastasia, Wanhainen Anders, Mani Kevin, Gormley Sinead, Khashram Manar, Mees Barend M E, Schurink Geert Willem H
Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Eur J Vasc Endovasc Surg. 2025 Jan;69(1):38-45. doi: 10.1016/j.ejvs.2024.07.023. Epub 2024 Jul 23.
The aim of this study was to describe the occurrence of branch thrombosis following endovascular treatment of aortic arch pathology using an arch branched device (ABD) and to determine whether this is influenced by clinical and geometric parameters.
In this retrospective observational study of patients treated with an ABD in three centres, the primary endpoint was thrombus formation within a branch during follow up. Secondary endpoints were technical success, serious adverse events (SAEs), early and late death, stroke, and re-interventions. Geometric measurements (tortuosity index and curvature) were determined on pre- and post-operative computed tomography angiograms.
Thirty nine patients were treated and 68 antegrade branches were analysed (innominate artery, n = 27; common carotid artery [CCA], n = 40; left subclavian artery [LSA], n = 1). Thrombus was identified within seven branches (10%) on surveillance imaging (innominate artery, n = 6; CCA, n = 1; LSA, n = 0; p = .021) and was associated with a wider distal bridging stent diameter (median 14.0 mm [13.3, 15.3] vs. 8.7 mm [IQR 5.9]; p = .026), a higher degree of reversed tapering (4.3 mm [3.8, 5.2] vs. 1.2 mm [0.3, 3.1]; p = .023), use of polyethylene terephthalate (Dacron) covered (vs. expanded polytetrafluoroethylene) bridging stents (23% vs. 2%; p = .011), and higher body mass index (BMI) (32.1 kg/m [28.7, 36.2] vs. 25.7 kg/m [23.8, 29.2]; p = .029), but not with pre-operative or post-operative tortuosity index or curvature or alterations. Regarding secondary outcomes, the technical success rate was 97%, SAEs occurred in 15 patients (38%), early and late death rates were 8% and 23%, respectively, and early and late stroke rates were 5% and 23%, respectively.
The risk of developing branch thrombosis after endovascular intervention with an ABD is considerable, especially of innominate artery branches, characterised by Dacron covered large diameter bridging stents, and in patients with a high BMI. Large prospective studies are required to analyse factors associated with branch thrombosis.
本研究旨在描述使用主动脉弓分支装置（ABD）对主动脉弓病变进行血管内治疗后分支血栓形成的情况，并确定其是否受临床和几何参数的影响。
在这项对三个中心接受ABD治疗的患者进行的回顾性观察研究中，主要终点是随访期间分支内血栓形成。次要终点包括技术成功、严重不良事件（SAE）、早期和晚期死亡、中风及再次干预。在术前和术后计算机断层扫描血管造影上测定几何测量值（迂曲指数和曲率）。
共治疗39例患者，分析了68个顺行分支（无名动脉，n = 27；颈总动脉[CCA]，n = 40；左锁骨下动脉[LSA]，n = 1）。在监测成像中，7个分支（10%）发现血栓（无名动脉，n = 6；CCA，n = 1；LSA，n = 0；p = 0.021），且与更宽的远端桥接支架直径相关（中位数14.0 mm [13.3, 15.3] 对比 8.7 mm [四分位间距5.9]；p = 0.026），更高程度的反向锥形化（4.3 mm [3.8, 5.2] 对比 1.2 mm [0.3, 3.1]；p = 0.023），使用聚对苯二甲酸乙二酯（涤纶）覆膜（对比膨体聚四氟乙烯）桥接支架（23% 对比 2%；p = 0.011），以及更高的体重指数（BMI）（32.1 kg/m [28.7, 36.2] 对比 25.7 kg/m [23.8, 29.2]；p = 0.029），但与术前或术后迂曲指数、曲率或改变无关。关于次要结局，技术成功率为97%，15例患者（38%）发生SAE，早期和晚期死亡率分别为8%和23%，早期和晚期中风率分别为5%和23%。
使用ABD进行血管内干预后发生分支血栓形成的风险相当大，尤其是无名动脉分支，其特征为涤纶覆膜大直径桥接支架，且在BMI高的患者中。需要进行大型前瞻性研究以分析与分支血栓形成相关的因素。
