目的:报告了B型壁内血肿(IMH)单中心经验中最佳药物治疗(BMT)和介入治疗(INT)的结果。
方法:从2015年2月至2021年2月,共纳入195例B型IMH连续患者。主要终点是死亡率,次要终点包括临床和影像学结局.临床结果为主动脉相关性死亡,逆行A型主动脉夹层,支架移植物引起的新的进入撕裂,内漏,和重新干预。通过最新的随访计算机断层扫描血管造影评估成像结果,包括主动脉破裂,主动脉夹层,主动脉瘤,主动脉直径快速增长,新出现或扩大的穿透性主动脉溃疡或溃疡样突起(ULP)和主动脉壁厚度增加。使用Kaplan-Meier曲线评估不同处理之间的关联。
结果:在入选患者中,115收到BMT,80人获得了智力。BMT组和INT组的早期(1.7%vs2.5%;P=1.00)和中期全因死亡(8.3%vs5.2%;P=.42)没有显着差异。然而,接受INT的患者存在手术相关并发症的风险,如支架移植物引起的新的进入撕裂和内漏.INT组与ULP的风险大大降低有关,包括新开发的ULP(4.3%对26.9%;P<0.05),ULP增大(6.4%vs31.3%;P<.05),高危ULP的比例较低(10.9%vs45.6%;P<.05)。虽然两组间IMH消退的发生率无显著差异,与接受BMT治疗的患者相比,接受INT治疗的患者降主动脉的最大直径更大.
结论:根据我们有限的经验,接受BMT或INT治疗的B型IMH患者的中期临床结局相似.接受INT的患者可能会降低ULP的风险,但手术相关事件的风险较高,BMT患者应密切监测ULP进展.
OBJECTIVE: The outcomes of the best medical treatment (BMT) and intervention treatment (INT) in a single-center experience were reported in type B intramural hematoma (IMH).
METHODS: From February 2015 to February 2021, a total of 195 consecutive patients with type B IMH were enrolled in the study. The primary end point was mortality, and the secondary end points included clinical and imaging outcomes. The clinical outcomes were aortic-related death, retrograde type A aortic dissection, stent graft-induced new entry tear, endoleak, and reintervention. The imaging outcome was evaluated through the latest follow-up computed tomography angiography, which included aortic rupture, aortic dissection, aortic aneurysm, rapid growth of aortic diameter, newly developed or enlarged penetrating aortic ulcer or ulcer-like projection (ULP) and increased aortic wall thickness. Kaplan-Meier curves were used to assess the association between different treatments.
RESULTS: Among the enrolled patients, 115 received BMT, and 80 received INT. There was no significant difference in early (1.7% vs 2.5%; P = 1.00) and midterm all-cause death (8.3% vs 5.2%; P = .42) between the BMT and INT groups. However, patients who underwent INT were at risk of procedure-related complications such as stent graft-induced new entry tear and endoleaks. The INT group was associated with a profound decrease in the risk of ULP, including newly developed ULP (4.3% vs 26.9%; P < .05), ULP enlargement (6.4% vs 31.3%; P < .05), and a lower proportion of high-risk ULP (10.9% vs 45.6%; P < .05). Although there was no significant difference in the incidence of IMH regression between the two groups, the maximum diameter of the descending aorta in patients receiving INT was larger compared with those treated with BMT.
CONCLUSIONS: Based on our limited experience, patients with type B IMH treated with BMT or INT shared similar midterm clinical outcome. Patients who underwent INT may have a decreased risk of ULPs, but a higher risk of procedure-related events and patients on BMT should be closely monitored for ULP progression.