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.	孫立忠, 李建榮. 我國 Stanford A 型主動脈夾層診療進展與挑戰. 中華外科雜志, 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.	張學民, 張韜, 張小明. 腔內隔絕術在累及升主動脈夾層中的應用及療效評估. 中華普通外科雜志, 2016, 31(2): 130-133.
7.	于坤, 常謙, 李景文, 等. 主動脈Ⅱ型弓部雜交手術治療升主動脈及弓降部病變. 中國體外循環雜志, 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.	李棟林, 張鴻坤, 李鳴. Stanford B 型主動脈夾層腔內修復術后主動脈重塑與夾層形態學理論建立. 中華普通外科雜志, 2015, 30(11): 920-922.
10.	韓磊, 萬珊杉, 王家平, 等. 不同期 Stanford B 型胸主動脈夾層腔內修復術后療效及主動脈重塑臨床研究. 介入放射學雜志, 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.	劉宸鋮, 郭應強, 蒙煒, 等. 全主動脈弓置換加支架象鼻手術治療 A 型主動脈夾層. 中國胸心血管外科臨床雜志, 2009, 16(2): 148-149.
14.	王韌, 薛玉國, 黃小勇, 等. 支架象鼻術后支架遠端破口的腔內修復治療. 中華胸心血管外科雜志, 2013, 29(12): 722-725.
15.	劉巍, 孫立忠, 朱俊明, 等. " 象鼻”手術治療覆膜支架腔內修復術后近端逆行剝離新發破口. 心肺血管病雜志, 2012, 31(1): 24-26.
16.	慈紅波, 方青波, 戈小虎. 胸主動脈腔內修復術后再破口研究進展. 國際外科學雜志, 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.	章思夢, 馮家烜, 陸清聲, 等. 限制性裸支架在主動脈夾層腔內治療中的應用. 中華普通外科雜志, 2015, 30(8): 599-603.
20.	孟慶友, 黃浩岳, 余云生, 等. 限制性裸支架在 Standord B 型主動脈夾層治療中的療效評價. 中國急救醫學, 2016, 36(z1): 145-146.
21.	董智慧, 李永生, 符偉國, 等. 基于個體 CT 影像的胸主動脈-血管內支架數值仿真初探. 中國臨床醫學, 2013, 20(1): 1-4.
22.	馮家烜, 陸清聲, 趙志青, 等. 限制性裸支架預防腔內隔絕術后支架移植物遠端再發夾層的研究. 中華普通外科雜志, 2013, 28(12): 926-930.
23.	周春暉, 歐陽洋, 李剛, 等. 胸主動脈腔內修復術聯合限制性裸支架治療 B 型主動脈夾層對術后主動脈重塑的影響. 中國普通外科雜志, 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, 王東進. 150 例 A 型主動脈夾層患者解剖參數及其臨床意義分析. 臨床外科雜志, 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. 孫立忠, 李建榮. 我國 Stanford A 型主動脈夾層診療進展與挑戰. 中華外科雜志, 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. 張學民, 張韜, 張小明. 腔內隔絕術在累及升主動脈夾層中的應用及療效評估. 中華普通外科雜志, 2016, 31(2): 130-133.
7. 于坤, 常謙, 李景文, 等. 主動脈Ⅱ型弓部雜交手術治療升主動脈及弓降部病變. 中國體外循環雜志, 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. 李棟林, 張鴻坤, 李鳴. Stanford B 型主動脈夾層腔內修復術后主動脈重塑與夾層形態學理論建立. 中華普通外科雜志, 2015, 30(11): 920-922.
10. 韓磊, 萬珊杉, 王家平, 等. 不同期 Stanford B 型胸主動脈夾層腔內修復術后療效及主動脈重塑臨床研究. 介入放射學雜志, 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. 劉宸鋮, 郭應強, 蒙煒, 等. 全主動脈弓置換加支架象鼻手術治療 A 型主動脈夾層. 中國胸心血管外科臨床雜志, 2009, 16(2): 148-149.
14. 王韌, 薛玉國, 黃小勇, 等. 支架象鼻術后支架遠端破口的腔內修復治療. 中華胸心血管外科雜志, 2013, 29(12): 722-725.
15. 劉巍, 孫立忠, 朱俊明, 等. " 象鼻”手術治療覆膜支架腔內修復術后近端逆行剝離新發破口. 心肺血管病雜志, 2012, 31(1): 24-26.
16. 慈紅波, 方青波, 戈小虎. 胸主動脈腔內修復術后再破口研究進展. 國際外科學雜志, 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. 章思夢, 馮家烜, 陸清聲, 等. 限制性裸支架在主動脈夾層腔內治療中的應用. 中華普通外科雜志, 2015, 30(8): 599-603.
20. 孟慶友, 黃浩岳, 余云生, 等. 限制性裸支架在 Standord B 型主動脈夾層治療中的療效評價. 中國急救醫學, 2016, 36(z1): 145-146.
21. 董智慧, 李永生, 符偉國, 等. 基于個體 CT 影像的胸主動脈-血管內支架數值仿真初探. 中國臨床醫學, 2013, 20(1): 1-4.
22. 馮家烜, 陸清聲, 趙志青, 等. 限制性裸支架預防腔內隔絕術后支架移植物遠端再發夾層的研究. 中華普通外科雜志, 2013, 28(12): 926-930.
23. 周春暉, 歐陽洋, 李剛, 等. 胸主動脈腔內修復術聯合限制性裸支架治療 B 型主動脈夾層對術后主動脈重塑的影響. 中國普通外科雜志, 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, 王東進. 150 例 A 型主動脈夾層患者解剖參數及其臨床意義分析. 臨床外科雜志, 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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