作者：叶小强1，冯钢1，黄磊1，欧阳春1，李海艳2，达青恩1，欧阳昆富1，韩振1，任明明1

单位：

1.518000广东省深圳市，北京大学深圳医院心血管外科　2.518000广东省深圳市，北京大学深圳医院内分泌科

Units：

1.Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China2.Department of Endocrinology, Peking University Shenzhen Hospital, Shenzhen 518000, China

关键词：

动脉瘤；主动脉弓部动脉瘤；Castor支架；左颈总动脉烟囱支架；治疗结果

Keywords：

Aneurysm; Aortic arch aneurysm; Castor stent; Left common carotid artery chimney stent; Treatment outcome

CLC：

R 543.16

DOI：

10.12114/j.issn.1008-5971.2022.00.204

Funds：

国家自然科学基金青年基金项目（82103383）；深圳市科技创新委员会基础研究专项面上项目（JCYJ20210324105603009）

摘要：

目的　探讨Castor支架联合左颈总动脉烟囱支架技术治疗主动脉弓部动脉瘤的效果。方法　回顾性选取2019年6月至2020年6月就诊于北京大学深圳医院的主动脉弓部动脉瘤患者5例。所有患者接受Castor支架联合左颈总动脉烟囱支架技术治疗，主体支架锚定点在Z1区。患者分别于术后1、6、12个月及之后每年返院复查一次全主动脉CTA，观察治疗效果以及随访结果。结果　5例患者均手术成功，平均手术时间为（198.0±44.4）min，术中未发现明显内漏，住院期间未出现卒中、围术期死亡及逆撕夹层，所有患者穿刺口愈合良好，无假性动脉瘤及伤口愈合不良情况，平均术后住院时间为（8.8±4.2）d。平均随访时间为（17.0±4.1）个月，随访期间所有患者未见支架移位、内漏发生，原动脉瘤瘤体内未见造影剂充盈，未见烟囱支架及Castor支架折断、狭窄、闭塞，未进行二次手术。患者术后瘤体最大直径小于术前（P ＜0.05）。瘤体最大直径缩小平均为（11.2±6.8）mm。无一例患者发生胸主动脉腔内修复术（TEVAR）相关死亡。1例患者于术后8个月出现右侧肢体乏力，MR检查提示左侧卵圆孔区急性脑梗死，不排除支架相关脑梗死，1例患者发生TEVAR相关脑梗死。结论　Castor支架联合左颈总动脉烟囱支架技术作为全腔内治疗技术可安全且有效地治疗累及Z2区的主动脉弓部动脉瘤，且其可重复性较高。

Abstract：

Objective　To investigate the effect of Castor stent combined with left common carotid artery chimneystent technology in the treatment of aortic arch aneurysm. Methods　Five patients with aortic arch aneurysm who were admittedto Peking University Shenzhen Hospital from June 2019 to June 2020 were retrospectively selected. All patients received Castorstent combined with left common carotid artery chimney stent technology treatment, and the anchoring point of the main stentwas in the Z1 area. The patients were returned to the hospital for re-examination of total aortic CTA at 1 month, 6 months, and12 months after the operation, and the effect and the results of the follow-up were observed. Results　All 5 patients underwentsuccessful surgery. The average operation time was (198.0±44.4) min. No obvious endoleak was found during the operation. Nostroke, perioperative death, or reverse dissection occurred during hospitalization. All patients healed well. No pseudoaneurysmand poor wound healing were found, and the average postoperative hospital stay was (8.8±4.2) d. The average follow-up time was(17.0±4.1) months. During the follow-up period, no stent displacement or endoleak occurred in all patients, no contrast agentfilling was found in the original aneurysm, and no fracture, stenosis and occlusion of the chimney stent and Castor stent were found.There was no secondary surgical intervention. The average maximum diameter of the aneurysm after operation was smaller thanthat before operation (P < 0.05) . The maximum diameter of the tumor was reduced by an average of (11.2±6.8) mm. No patienthad thoracic endovascular aortic repair (TEVAR)-related death. One patient developed right limb weakness at 8 months afteroperation. MR examination showed acute cerebral infarction in the left foramen ovale. Stent-related cerebral infarction could notbe ruled out. One patient had TEVAR-related cerebral infarction. Conclusion　Castor stent combined with left common carotidartery chimney stent technology as a total endoluminal therapy technique can safely and effectively treat aortic arch aneurysmsinvolving Z2 area with high reproducibility.

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