Zhou Sangyu, Liu Yanxiang, Zhang Bowen, Wang Luchen, Zhao Ruojin, Xie Mingxing, Chen Xuyang, Yu Cuntao, Dun Yaojun, Sun Xiaogang
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
J Am Heart Assoc. 2025 Aug 5;14(15):e041804. doi: 10.1161/JAHA.125.041804. Epub 2025 Jul 29.
The presence of an isolated left vertebral artery (ILVA) in patients with aortic dissection is a rare and challenging condition. This study aims to determine the optimal management of ILVA in patients with aortic dissection undergoing total arch replacement with frozen elephant trunk.
This retrospective study enrolled 94 patients with ILVA and aortic dissection who underwent total arch replacement with frozen elephant trunk. Patients were divided into 3 groups: 18 patients underwent ligation of ILVA, 52 underwent ILVA-left subclavian artery transposition, and 24 underwent ILVA-left common carotid artery transposition.
Vertebral artery dominance was left dominant in 10.6%, symmetric in 33.0%, and right dominant in 56.4% of patients. Notably, patients who underwent ligation of ILVA had either symmetric or right-dominant vertebral arteries, with no left-dominant cases. No strokes were observed. Paraplegia/paraparesis (11.1% versus 11.5% versus 0%, =0.223), mechanical ventilation time (45 [10-61] hour versus 18 [11-38] hour versus 15 [11-51] hour, =0.855), and long-term survival (log-rank =0.419) were comparable among the 3 groups. Follow-up computed tomographic angiography confirmed patency of the left vertebral artery in all patients who underwent ILVA transposition.
Ligation of ILVA, ILVA-left subclavian artery transposition, and ILVA-left common carotid artery transposition are all feasible and safe strategies for managing ILVA in patients with aortic dissection undergoing total arch replacement with frozen elephant trunk.
主动脉夹层患者中孤立性左椎动脉（ILVA）的存在是一种罕见且具有挑战性的情况。本研究旨在确定在接受带膜支架象鼻全弓置换术的主动脉夹层患者中ILVA的最佳治疗方法。
这项回顾性研究纳入了94例患有ILVA和主动脉夹层并接受带膜支架象鼻全弓置换术的患者。患者分为3组：18例患者接受了ILVA结扎术，52例接受了ILVA-左锁骨下动脉转位术，24例接受了ILVA-左颈总动脉转位术。
椎动脉优势情况为：10.6%的患者为左侧优势，33.0%为双侧对称，56.4%为右侧优势。值得注意的是，接受ILVA结扎术的患者椎动脉为双侧对称或右侧优势，无左侧优势病例。未观察到中风事件。三组患者的截瘫/轻截瘫发生率（11.1%对11.5%对0%，P=0.223）、机械通气时间（45[10-61]小时对18[11-38]小时对15[11-51]小时，P=0.855）和长期生存率（对数秩检验P=0.419）相当。随访计算机断层血管造影证实，所有接受ILVA转位术的患者左椎动脉均通畅。
对于接受带膜支架象鼻全弓置换术的主动脉夹层患者，ILVA结扎术、ILVA-左锁骨下动脉转位术和ILVA-左颈总动脉转位术都是治疗ILVA可行且安全的策略。
