在一组 B 型主动脉夹层患者中比较烟囱技术和单支支架移植物:一项回顾性队列研究。

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular diagnosis and therapy Pub Date : 2024-06-30 Epub Date: 2024-06-17 DOI:10.21037/cdt-23-449
Yue Xing, Zhengrong Zhu, Lan Zou, Jiayu Wu, Guojian Xu, Yiding Xu, Zhijian He, Jianqiang Cao, Canhua Luo
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引用次数: 0

摘要

背景:单支支架移植物和烟囱技术被广泛用于治疗B型主动脉夹层(TBAD)。本研究的主要目的是比较单支支架移植物和烟囱技术在治疗TBAD中的疗效:从 2019 年 1 月到 2021 年 12 月,这项回顾性队列研究包含了 91 名接受胸腔内血管主动脉修补术(TEVAR)的 TBAD 患者,他们分别使用了单支支架移植物和烟囱技术。A 组包括 55 名接受单支覆盖支架治疗的患者,B 组包括 36 名接受烟囱技术治疗的患者。我们比较了两组手术对围手术期/术后效果的影响。主要终点是临床死亡,次要终点包括分支支架的通畅性、脑梗塞发生率、假腔血栓形成以及截瘫比例:就基线数据而言,两组患者在年龄、性别和相关症状方面没有差异。两组患者均成功实施了所有手术。中位随访时间为 17.6 个月(10-34 个月)。在 TEVAR 过程中,A 组发生了 5 例(9.1%)I 型内漏,B 组发生了 11 例(30.6%)(PConclusions:与烟囱技术相比,分支支架移植物可用于近端着床区不足的病例,并能减少1型内漏的发生。这可能有助于预防 RTAD。要证实这些结果,还需要进一步的研究,包括更多的病例和更长的随访时间。
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Comparison of chimney technique and single-branched stent graft in a cohort of patients with type B aortic dissections: a retrospective cohort study.

Background: Single-branched stent grafts and the chimney technique are widely used in the treatment of type B aortic dissection (TBAD). The main objective of this study was to compare the outcomes of single-branched stent grafts and the chimney technique in the treatment of TBAD.

Methods: From January 2019 to December 2021, the retrospective cohort study contained a cohort of 91 patients with TBAD undergoing thoracic endovascular aortic repair (TEVAR) using single-branched stent grafts and the chimney technique. Group A included 55 patients treated with single-branched covered stents, and Group B included 36 patients treated with the chimney technique. We compared the effects of the procedures on peri-/post-operative outcomes between the two groups. The primary endpoint is clinical death, and the secondary endpoints include the patency of branch stents, the incidence of cerebral infarction, false lumen thrombosis, and the proportion of paraplegia.

Results: For the baseline data, the two groups of patients show no differences in terms of age, gender, and associated symptoms. All procedures were successfully performed in both groups. The median follow-up period was 17.6 months (range, 10-34 months). During TEVAR, 5 (9.1%) type I endoleaks occurred in group A, and 11 (30.6%) occurred in group B (P<0.05). During follow-up, there were 2 cases (3.6%) of paraplegia and 1 case (1.8%) of cerebral infarction in Group A, while Group B had 1 case (2.8%) of paraplegia. Three patients in group B reported retrograde type A aortic dissection (RTAD), and 1 of them died (2.8%); however, there were no RTAD cases in group A. Complete thrombosis of the false lumen in the thoracic aorta was observed in 45.5% (25/55) of patients in group A and in 41.7% (15/36) in group B (P=0.72). No significant difference in the thrombosis-volume ratio in the whole false lumen was found during follow-up between group A (81.0%±2.9%) and group B (81.8%±2.6%; P=0.23).

Conclusions: Branched stent grafts can be used in cases with insufficient proximal landing zones and reduce the occurrence of type 1 endoleak compared to the chimney technique. This may help to prevent RTAD. Further research, including more cases and longer follow-up periods, is needed to substantiate these results.

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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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