■在胸主动脉腔内修复术(TEVAR)期间保留左锁骨下动脉(LSA)与低发病率有关。这项研究调查了采用开窗腔内弓修复(f-Arch)治疗的患者LSA支架受压的发生率,并评估了解剖和技术因素对LSA支架结局的影响。
■对使用单开窗装置管理的患者的单中心回顾性分析(CookMedical,布卢明顿,IN,美国)用于LSA保存,在2012年1月1日至2023年11月30日期间进行。解剖学(足弓型,牛弓,LSA和最近骨结构之间的距离,左颈总动脉和主动脉病变,起飞角度,直径,血栓,钙化,解剖,弯曲度)和技术参数(支架类型,直径,长度,重新衬砌,扩张后)进行评估。与初始直径相比,支架压缩为支架的任何≥50%狭窄(使用中心腔线)。临床结果包括中风和30天的上肢缺血和随访。技术结果包括支架压缩和需要再干预。
■纳入54例。仅使用球囊扩张覆膜支架,在索引程序中进行了重新衬砌的比例为18%。没有记录到中风或手臂缺血。在30天检测到一个支架压缩。随访期间,未诊断出中风或手臂缺血。9例(18%)支架受压,在索引程序后18个月(四分位距[IQR]=37,范围=1-58个月)的平均支架压迫诊断时间。五人(56%)进行了二次换层。再次干预后的随访顺利。下距离最近的骨结构(压缩组[CG]:11.7±8.9mm,非压缩组[NCG]:23.0±7.8mm,p=0.003)和更高的弯曲指数(CG:1.3±0.4vsNCG:1.2±0.1,p=0.03)与LSA支架压缩相关。
■LSA支架压缩治疗5例f-Arch患者1例,没有临床后果。到最近的骨骼结构的距离和较高的弯曲度与LSA支架压缩有关。
结论:在需要在主动脉弓内着陆的患者中进行了保留左锁骨下动脉(LSA)的带孔腔内修复术,结果令人鼓舞。这项分析表明,18%的患者满足LSA支架压缩,虽然没有任何临床后果。术前解剖参数,由于到最近的骨结构的距离较低和弯曲指数较高对LSA支架性能产生负面影响,而支架参数似乎没有影响。
UNASSIGNED: Left subclavian artery (LSA) preservation during thoracic endovascular aortic repair (TEVAR) has been related to low morbidity. This study investigated the incidence of LSA stent
compression in patients managed with fenestrated endovascular arch repair (f-Arch) and evaluated the impact of anatomic and technical factors on LSA stent outcomes.
UNASSIGNED: A single-center retrospective analysis of patients managed with single-fenestration devices (Cook Medical, Bloomington, IN, USA) for LSA preservation, between January 1, 2012 and November 30, 2023, was conducted. Anatomic (arch type, bovine arch, distance between the LSA and most proximal bone structure, left common carotid artery and aortic lesion, take-off angle, diameter, thrombus, calcification, dissection, tortuosity) and technical parameters (stent type, diameter, length, relining, post-dilation) were evaluated. Stent compression was any ≥50% stenosis (using center luminal line) of the stent compared with its initial diameter. Clinical outcomes included stroke and upper limb ischemia at 30 days and follow-up. Technical outcomes included stent
compression and need for reintervention.
UNASSIGNED: Fifty-four cases were included. Only balloon-expandable covered stents were used, and relining during the index procedure was performed in 18%. No stroke or arm ischemia was recorded. One stent
compression was detected at 30 days. During follow-up, no stroke or arm ischemia was diagnosed. Nine cases (18%) presented stent
compression, with a mean time of stent-
compression diagnosis at 18 months (interquartile range [IQR]=37, range=1-58 months) after the index procedure. Five (56%) underwent secondary relining. Follow-up after reintervention was uneventful. Lower distance to the nearest bone structure (
compression group [CG]: 11.7±8.9 mm vs non-
compression group [NCG]: 23.0±7.8 mm, p=0.003) and higher tortuosity index (CG: 1.3±0.4 vs NCG: 1.2±0.1, p=0.03) were associated with LSA stent compression.
UNASSIGNED: LSA stent compression in patients managed with f-Arch affected 1 in 5 cases, without clinical consequences. Distance to the nearest bone structure and higher tortuosity were associated with LSA stent compression.
CONCLUSIONS: Fenestrated endovascular arch repair for the preservation of the left subclavian artery (LSA) in patients needing landing within the aortic arch has been performed with encouraging outcomes. This analysis showed that LSA stent compression is met in 18% of patients, without though any clinical consequence. Pre-operative anatomic parameters, as lower distance to the nearest bone structure and higher tortuosity index affect negatively LSA stent performance while stent parameters seem to have no impact.