Castor支架型人工血管治疗累及左锁骨下动脉的B型主动脉夹层的中期疗效：一项回顾性单中心研究

Midterm Outcomes of Castor Stent Graft in Treatment of Type B Aortic Dissection Involving Left Subclavian Artery: A Retrospective Single-Center Study.

作者信息

Li Mixia, Yuan Lei, Wang Duo, Wang Yong, Piao Hulin, Liu Kexiang

机构信息

Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China.

出版信息

Catheter Cardiovasc Interv. 2025 Aug;106(2):1233-1243. doi: 10.1002/ccd.31643. Epub 2025 Jun 8.

DOI:10.1002/ccd.31643

PMID:40485146

Abstract

OBJECTIVE

For type B aortic dissection (TBAD) involving the left subclavian artery (LSA), to secure sufficient proximal landing zones, the LSA can be intentionally covered during thoracic endovascular aortic repair (TEVAR). This study aimed to evaluate the midterm clinical outcomes of endovascular treatment for TBAD involving the LSA using the Castor single-branched stent graft.

AIMS

The aim of this study was to evaluate the midterm efficacy and safety of Cator stent graft in the treatment of type B aortic dissection involving left subclavian artery.

METHODS

From May 2018 to December 2022, 150 patients with TBAD involving the LSA were treated with the Castor single-branched stent graft (Micropart Corp, Shanghai, China). The data collected included technical success, incidences of Type I endoleak, retrograde type A dissection (RTAD), stroke, LSA patency, as well as follow-up mortality and morbidity, and reinterventions.

RESULTS

The technical success rate was 97.3% (146/150). One patient experienced intraoperative RTAD, two patients had a small type I endoleak, and one patient suffered a stroke. Moreover, one patient developed RTAD on the third day after TEVAR. No in-hospital aorta-related mortality, paraplegia, or branch occlusion. During follow-up, one case (0.7%) of small endoleak, one case (0.7%) of branch occlusion, and two deaths were documented. Complete thrombosis of the false lumens was observed in 140 cases (99.3%). The true lumen diameter at the level of the aortic isthmus and pulmonary artery bifurcation increased significantly (13.3 ± 7.5 vs. 4.2 ± 2.1; 19.8 ± 5.7 vs. 5.4 ± 4.8, p < 0.01), and the ratio of the real lumen increased significantly (0.6 ± 0.2 vs. 0.9 ± 0.1; 0.4 ± 0.1 vs. 0.8 ± 0.1, p < 0.01). The median follow-up time was 36.0 months (IQR, 11.8 months) (range: 6-72 months).

CONCLUSION

The Castor single-branched stent graft showed favorable midterm outcomes in the treatment of TBAD involving the LSA.

摘要

目的

对于累及左锁骨下动脉（LSA）的B型主动脉夹层（TBAD），为确保有足够的近端锚定区，在胸主动脉腔内修复术（TEVAR）期间可有意覆盖LSA。本研究旨在评估使用Castor单分支覆膜支架治疗累及LSA的TBAD的中期临床疗效。

目的

本研究的目的是评估Cator覆膜支架治疗累及左锁骨下动脉的B型主动脉夹层的中期疗效和安全性。

方法

2018年5月至2022年12月，150例累及LSA的TBAD患者接受了Castor单分支覆膜支架（中国上海微创医疗器械（集团）有限公司）治疗。收集的数据包括技术成功率、I型内漏、逆行A型夹层（RTAD）、卒中的发生率、LSA通畅情况，以及随访期间的死亡率、发病率和再次干预情况。

结果

技术成功率为97.3%（146/150）。1例患者术中发生RTAD，2例患者出现小的I型内漏，1例患者发生卒中。此外，1例患者在TEVAR术后第3天发生RTAD。无院内主动脉相关死亡、截瘫或分支闭塞。随访期间，记录到1例（0.7%）小内漏、1例（0.7%）分支闭塞和2例死亡。140例（99.3%）观察到假腔完全血栓形成。主动脉峡部和肺动脉分叉水平的真腔直径显著增加（13.3±7.5对4.2±2.1；19.8±5.7对5.4±4.8，p<0.01），真腔比例显著增加（0.6±0.2对0.9±0.1；0.4±0.1对0.8±0.1，p<0.01）。中位随访时间为36.0个月（IQR，11.8个月）（范围：6 - 72个月）。