山东省潍坊市人民医院 血管外科,山东 潍坊 261000




Feasibility and efficacy of using Castor stent for reconstruction of the left common carotid artery in aortic arch lesions

Department of Vascular Surgery, Weifang People's Hospital, Weifang, Shandong 261000, China

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    背景与目的 胸主动脉腔内修复术(TEVAR)已成为治疗主动脉弓病变的首选方法。如何重建主动脉弓上分支,是TEVAR的难点和研究方向之一。目前,Castor单分支主动脉覆膜支架广泛应用于TEVAR术中重建左锁骨下动脉,但其应用于重建左颈总动脉(LCCA)报道少见。因此,本研究探讨TEVAR术中运用Castor单分支主动脉覆膜支架在TEVAR术中重建LCCA的可行性和有效性。方法 回顾2021年10月—2022年9月潍坊市人民医院血管外科收治的5例累及Z2区的主动脉弓病变患者资料,患者均为男性;年龄39~77岁,平均(59.2±14.08)岁,其中急性Stanford B型主动脉夹层3例,主动脉弓动脉瘤2例。所有患者均在数字减影血管造影引导下采用Castor一体化分支型主动脉覆膜支架在TEVAR术中重建LCCA。分析手术相关指标及术后不良事件发生率,以及术后随访6个月内不良事件的发生情况与主动脉重塑情况。结果 5例患者均手术成功。手术时间168~233 min,平均(191±19.06)min,无中转开胸手术。5例患者的LCCA均成功采用Castor单分支支架行血运重建。术后住院期间发生1例脑卒中,术后2个月意识清晰,右上肢肌力完全恢复(Ⅴ级);其余4例患者住院及随访期间无全因死亡、脑卒中、支架移位、夹层复发、内漏、截瘫、左上肢缺血等并发症。患者术后6个月复查主动脉CT血管造影显示Castor单分支支架位置良好,主动脉峡部平面主动脉平均直径与肺动脉分叉平面主动脉平均直径均较术前明显减小(35.8 mm vs. 41.9 mm,P=0.035;31.1 mm vs. 36.7 mm,P=0.048);主动脉及分支支架通畅率为100%,无内漏,瘤腔/假腔均出现血栓化。结论 在严格把握适应证的前提下,Castor单分支支架在TEVAR术中重建LCCA安全可行,然而,其疗效仍需更长时间的随访和更多的病例验证。


    Background and Aims Thoracic endovascular aortic repair (TEVAR) has become the preferred method for treating aortic arch lesions. One of the challenges and research directions in TEVAR is reconstructing the supra-aortic branches. The Castor single-branched stent graft is widely used to reconstruct the left subclavian artery during TEVAR. However, its application in reconstructing the left common carotid artery (LCCA) is rarely reported. Therefore, this study investigated the feasibility and efficacy of using the Castor single-branch stent graft to reconstruct the LCCA during TEVAR.Methods Five patients with aortic arch lesions involving Zone 2 treated in the Department of Vascular Surgery of Weifang People's Hospital from October 2021 to September 2022 were reviewed. All patients were males, aged between 39 and 77 years, with an average age of (59.2±14.08) years. Among them, three had acute Stanford type B aortic dissection, and two had aortic arch aneurysms. Under DSA guidance, all patients underwent TEVAR with the reconstruction of the LCCA using the Castor-integrated branched aortic-covered stent. The surgical-related variables, the incidence of postoperative adverse events, and the occurrence of adverse events and aortic remodeling within a six-month follow-up after the operation were analyzed.Results All five patients successfully underwent the surgery. The operative time ranged from 168 to 233 min, with an average of (191±19.06) min, and no conversions to thoracotomy were necessary. The LCCA was successfully reconstructed using the Castor single-branched stent in all patients. During the postoperative hospital stay, one patient experienced a stroke but recovered full right upper limb muscle strength (Grade V) with clear consciousness two months after the operation. The other four patients did not experience any all-cause death, stroke, stent migration, dissection recurrence, endoleak, paraplegia, or left upper limb ischemia during hospitalization and follow-up. Six months after surgery, aortic CTA re-examination showed that the Castor single-branched stent was well-positioned, with a significant reduction in the mean aortic diameter at the aortic isthmus and pulmonary artery bifurcation levels compared to preoperative measurements (35.8 mm vs. 41.9 mm, P=0.035; 31.1 mm vs. 36.7 mm, P=0.048). The patency rate of the aortic and branch stents was 100%, with no endoleak, and thrombus formation was observed in the aneurysmal/false lumen.Conclusion Under strict adherence to indications, the use of the Castor single-branched stent for LCCA reconstruction during TEVAR is safe and feasible. However, its efficacy requires longer follow-up and validation with more cases.

    表 3 主动脉重塑情况Table 3 Aortic remodeling results
    表 2 支架相关参数(mm)Table 2 Stent-related parameters (mm)
    表 1 患者一般资料及术前主动脉CTA数据Table 1 General data of patients and preoperative aortic CTA data
    图1 术前CTA检查 A:病例1;B:病例2;C:病例3;D:病例4;E:病例5Fig.1 Preoperative CTA examination A: Case 1; B: Case 2; C: Case 3; D: Case 4; E: Case 5
    图2 手术过程 A:术前造影;B:分支支架引入颈动脉;C:释放支架;D:术毕造影Fig.2 Stent deployment A: Preoperative angiography; B: Branch stent introduction into carotid artery; C: Stent deployment; D: Postoperative angiography
    图3 术后复查CTA A-C:典型病例术后复查CTA图像Fig.3 Postoperative CTA reexamination A-C: Typical postoperative follow-up CTA images of patients

孙文超,刘涛,裴长安,孙波,曹广信,张杰峰. Castor支架在主动脉弓病变中重建左颈总动脉的可行性和有效性研究[J].中国普通外科杂志,2024,33(6):909-917.
DOI:10.7659/j. issn.1005-6947.2024.06.006

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  • 收稿日期:2023-11-10
  • 最后修改日期:2024-05-13
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  • 在线发布日期: 2024-07-09