Efficacy of restrictive bare stent in the treatment of acute Stanford type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Sha ,  FU Jun , WANG Bo , WANG Yan , GAO Xiang

Department of Cardiovascular Surgery, Wuhan Asian Heart Hospital, Wuhan, 430022, P.R.China;

Corresponding author：

FU Jun, Email: 435753033@qq.com

Keywords：

Stanford type A aortic dissection; stented elephant trunk; bare stent; curative effect

DOI：

10.7507/1007-4848.201808029

Video：

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Objective To observe the efficacy of restrictive bare stent released on the distal end of the trunk of Stanford type A aortic dissection. Methods The clinical data of 22 patients with Stanford type A aortic dissection requiring aortic arch replacement and trunk surgery and selected for restrictive bare stent placement from November 2016 to February 2018 in our hospital were retrospectively analyzed. Among them, there were 19 males and 3 females, aged 34-68 (49.72±8.05) years. The bare stent was released in the descending thoracic aorta, and the stented elephant trunk was placed in the bare stent. The aortic computerized tomography angiography was reviewed before discharge and the stent position and complications were observed. Results One patient failed to be implanted with bare stents due to a greater resistance and prolapse during implantation. Bare stents were successfully implanted in the remaining 21 patients. One patient died of large-area cerebral infarction after surgery and one patient suffered paraplegia. Twenty patients who survived and successfully implanted bare stents were followed up at regular intervals for 4-21 (13.00±6.14) months. No stroke or death occurred during the follow-up. The computerized tomography angiography showed good stent morphology and position, and no displacement or type Ⅲ endoleak. No stent graft-induced new entry was found. Conclusion As an adjunct to stented elephant trunk, the use of restrictive bare stents can reduce the possibility of recurrence of a distal stent fracture, significantly expand the narrowest segment and true lumen caliber near the endoluminal graft. Aortic remodeling works well.

Citation： LI Sha, FU Jun, WANG Bo, WANG Yan, GAO Xiang. Efficacy of restrictive bare stent in the treatment of acute Stanford type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(8): 744-747. doi: 10.7507/1007-4848.201808029 Copy

1.	Takagi H, Umemoto T, ALICE Group. A meta-analysis of total arch replacement with frozen elephant trunk in acute type A aortic dissection. Vasc Endovascular Surg, 2016, 50(1): 33-46.
2.	孙立忠, 李建荣. 我国 Stanford A 型主动脉夹层诊疗进展与挑战. 中华外科杂志, 2017, 55(4): 241-244.
3.	Follis F, Raffa GM, D’Ancona G, et al. Stanford type A acute retrograde aortic dissections: from surgical to endovascular strategy. Artif Organs, 2016, 40(4): 394-397.
4.	Zhao Y, Yin H, Chen Y, et al. Restrictive bare stent prevents distal stent graft-induced new entry in endovascular repair of type B aortic dissection. J Vasc Surg, 2017, 67(1): 93-103.
5.	Jang H, Kim MD, Kim GM, et al. Risk factors for stent graft-induced new entry after thoracic endovascular aortic repair for Stanford type B aortic dissection. J Vasc Surg, 2017, 65(3): 676-685.
6.	张学民, 张韬, 张小明. 腔内隔绝术在累及升主动脉夹层中的应用及疗效评估. 中华普通外科杂志, 2016, 31(2): 130-133.
7.	于坤, 常谦, 李景文, 等. 主动脉Ⅱ型弓部杂交手术治疗升主动脉及弓降部病变. 中国体外循环杂志, 2011, 9(2): 65-67, 92.
8.	Hirai H, Sasaki Y, Hosono M, et al. Surgical treatment for pseudoaneurysm of the sinus of valsalva ruptured into the right atrium after mycotic right coronary artery aneurysm repair; report of a case. Kyobu Geka, 2015, 68(2): 125-128.
9.	李栋林, 张鸿坤, 李鸣. Stanford B 型主动脉夹层腔内修复术后主动脉重塑与夹层形态学理论建立. 中华普通外科杂志, 2015, 30(11): 920-922.
10.	韩磊, 万珊杉, 王家平, 等. 不同期 Stanford B 型胸主动脉夹层腔内修复术后疗效及主动脉重塑临床研究. 介入放射学杂志, 2016, 5(11): 958-961.
11.	Kolvenbach C, Gao ZW, Karmeli R. Hybrid repair for ascending aortic dissections and aneurysms. J Endovasc Ther, 2017, 24(5): 152660281772505.
12.	Uchida N, Shibamura H, Katayama A, et al. Operative strategy for acute type a aortic dissection: ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk. Ann Thorac Surg, 2009, 87(3): 773-777.
13.	刘宸铖, 郭应强, 蒙炜, 等. 全主动脉弓置换加支架象鼻手术治疗 A 型主动脉夹层. 中国胸心血管外科临床杂志, 2009, 16(2): 148-149.
14.	王韧, 薛玉国, 黄小勇, 等. 支架象鼻术后支架远端破口的腔内修复治疗. 中华胸心血管外科杂志, 2013, 29(12): 722-725.
15.	刘巍, 孙立忠, 朱俊明, 等. " 象鼻”手术治疗覆膜支架腔内修复术后近端逆行剥离新发破口. 心肺血管病杂志, 2012, 31(1): 24-26.
16.	慈红波, 方青波, 戈小虎. 胸主动脉腔内修复术后再破口研究进展. 国际外科学杂志, 2015, 42(12): 838-841.
17.	Dong Z, Fu W, Wang Y, et al. Stent graft-induced new entry after endovascnlar repair for stanford type B aortic dissection. J Vasc Surg, 2010, 52(6): 1450-1457.
18.	Ma WG, Zhang W, Wang LF, et al. Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period. J Thorac Cardiovasc Surg, 2016, 151(6): 1581-1592.
19.	章思梦, 冯家烜, 陆清声, 等. 限制性裸支架在主动脉夹层腔内治疗中的应用. 中华普通外科杂志, 2015, 30(8): 599-603.
20.	孟庆友, 黄浩岳, 余云生, 等. 限制性裸支架在 Standord B 型主动脉夹层治疗中的疗效评价. 中国急救医学, 2016, 36(z1): 145-146.
21.	董智慧, 李永生, 符伟国, 等. 基于个体 CT 影像的胸主动脉-血管内支架数值仿真初探. 中国临床医学, 2013, 20(1): 1-4.
22.	冯家烜, 陆清声, 赵志青, 等. 限制性裸支架预防腔内隔绝术后支架移植物远端再发夹层的研究. 中华普通外科杂志, 2013, 28(12): 926-930.
23.	周春晖, 欧阳洋, 李刚, 等. 胸主动脉腔内修复术联合限制性裸支架治疗 B 型主动脉夹层对术后主动脉重塑的影响. 中国普通外科杂志, 2016, 25(2): 1694-1700.
24.	Cho K, Jeong J, Park J, et al. Long-term changes in the distal aorta after aortic arch replacement in acute debakey type Ⅰ aortic dissection. Korean J Thorac Cardiovasc Surg, 2016, 49(4): 264-272.
25.	潘亮, 莫然, 王东进. 150 例 A 型主动脉夹层患者解剖参数及其临床意义分析. 临床外科杂志, 2017, 25(5): 360-362.

1. Takagi H, Umemoto T, ALICE Group. A meta-analysis of total arch replacement with frozen elephant trunk in acute type A aortic dissection. Vasc Endovascular Surg, 2016, 50(1): 33-46.
2. 孙立忠, 李建荣. 我国 Stanford A 型主动脉夹层诊疗进展与挑战. 中华外科杂志, 2017, 55(4): 241-244.
3. Follis F, Raffa GM, D’Ancona G, et al. Stanford type A acute retrograde aortic dissections: from surgical to endovascular strategy. Artif Organs, 2016, 40(4): 394-397.
4. Zhao Y, Yin H, Chen Y, et al. Restrictive bare stent prevents distal stent graft-induced new entry in endovascular repair of type B aortic dissection. J Vasc Surg, 2017, 67(1): 93-103.
5. Jang H, Kim MD, Kim GM, et al. Risk factors for stent graft-induced new entry after thoracic endovascular aortic repair for Stanford type B aortic dissection. J Vasc Surg, 2017, 65(3): 676-685.
6. 张学民, 张韬, 张小明. 腔内隔绝术在累及升主动脉夹层中的应用及疗效评估. 中华普通外科杂志, 2016, 31(2): 130-133.
7. 于坤, 常谦, 李景文, 等. 主动脉Ⅱ型弓部杂交手术治疗升主动脉及弓降部病变. 中国体外循环杂志, 2011, 9(2): 65-67, 92.
8. Hirai H, Sasaki Y, Hosono M, et al. Surgical treatment for pseudoaneurysm of the sinus of valsalva ruptured into the right atrium after mycotic right coronary artery aneurysm repair; report of a case. Kyobu Geka, 2015, 68(2): 125-128.
9. 李栋林, 张鸿坤, 李鸣. Stanford B 型主动脉夹层腔内修复术后主动脉重塑与夹层形态学理论建立. 中华普通外科杂志, 2015, 30(11): 920-922.
10. 韩磊, 万珊杉, 王家平, 等. 不同期 Stanford B 型胸主动脉夹层腔内修复术后疗效及主动脉重塑临床研究. 介入放射学杂志, 2016, 5(11): 958-961.
11. Kolvenbach C, Gao ZW, Karmeli R. Hybrid repair for ascending aortic dissections and aneurysms. J Endovasc Ther, 2017, 24(5): 152660281772505.
12. Uchida N, Shibamura H, Katayama A, et al. Operative strategy for acute type a aortic dissection: ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk. Ann Thorac Surg, 2009, 87(3): 773-777.
13. 刘宸铖, 郭应强, 蒙炜, 等. 全主动脉弓置换加支架象鼻手术治疗 A 型主动脉夹层. 中国胸心血管外科临床杂志, 2009, 16(2): 148-149.
14. 王韧, 薛玉国, 黄小勇, 等. 支架象鼻术后支架远端破口的腔内修复治疗. 中华胸心血管外科杂志, 2013, 29(12): 722-725.
15. 刘巍, 孙立忠, 朱俊明, 等. " 象鼻”手术治疗覆膜支架腔内修复术后近端逆行剥离新发破口. 心肺血管病杂志, 2012, 31(1): 24-26.
16. 慈红波, 方青波, 戈小虎. 胸主动脉腔内修复术后再破口研究进展. 国际外科学杂志, 2015, 42(12): 838-841.
17. Dong Z, Fu W, Wang Y, et al. Stent graft-induced new entry after endovascnlar repair for stanford type B aortic dissection. J Vasc Surg, 2010, 52(6): 1450-1457.
18. Ma WG, Zhang W, Wang LF, et al. Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period. J Thorac Cardiovasc Surg, 2016, 151(6): 1581-1592.
19. 章思梦, 冯家烜, 陆清声, 等. 限制性裸支架在主动脉夹层腔内治疗中的应用. 中华普通外科杂志, 2015, 30(8): 599-603.
20. 孟庆友, 黄浩岳, 余云生, 等. 限制性裸支架在 Standord B 型主动脉夹层治疗中的疗效评价. 中国急救医学, 2016, 36(z1): 145-146.
21. 董智慧, 李永生, 符伟国, 等. 基于个体 CT 影像的胸主动脉-血管内支架数值仿真初探. 中国临床医学, 2013, 20(1): 1-4.
22. 冯家烜, 陆清声, 赵志青, 等. 限制性裸支架预防腔内隔绝术后支架移植物远端再发夹层的研究. 中华普通外科杂志, 2013, 28(12): 926-930.
23. 周春晖, 欧阳洋, 李刚, 等. 胸主动脉腔内修复术联合限制性裸支架治疗 B 型主动脉夹层对术后主动脉重塑的影响. 中国普通外科杂志, 2016, 25(2): 1694-1700.
24. Cho K, Jeong J, Park J, et al. Long-term changes in the distal aorta after aortic arch replacement in acute debakey type Ⅰ aortic dissection. Korean J Thorac Cardiovasc Surg, 2016, 49(4): 264-272.
25. 潘亮, 莫然, 王东进. 150 例 A 型主动脉夹层患者解剖参数及其临床意义分析. 临床外科杂志, 2017, 25(5): 360-362.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of restrictive bare stent in the treatment of acute Stanford type A aortic dissection

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