iFlow技术于TEVAR术中辅助判断左锁骨下动脉烟囱支架植入疗效

摘要

ObjectivesUsing iFlow technology to evaluate actually the inlfuence of left subclavian artery (LSA) stent to blood flow for the patients with the left subclavian artery ‘chimney’ stent implantation (LSACSI) during thoracic endovascular aortic repair (TEVAR), as well combined with the following-up with postoperative aortic CTA to assess the inlfuence factors of patency rate of chimney stent.MethodsFrom 2013 to 2013, retrospective analysis , patients (130 males and 84 female mean age 60.31± 5.46 years) suffered with Stanford type B aortic dissection (AD) in our department were underwent TEVAR, in which 192 patients with single TEVAR and 22 patients with TEVAR and LSACSI. iFlow software was used to analyze the image of patients with pre- and post- operative thoracic aortic angiography, in which the region of interest (ROI) were designed at the arch of aorta (pre- stent grafts), the beginning of innominate artery, LSA, left vertebral artery (LVA), and left axillary artery (LAA) in the middle level, respectively. The parameters were collected as ROI Area, ROI Peak/Ref Peak, ROI Peak Time, and ROI AUC/Ref AUC in statistical analysis.Results There were no signiifcant differences in ROI of patients underwent TEVAR with LSACSI, in comparison to without LSACSI based on ROI Peak Time.ConclusionFor patients suffered with Stanford type B AD but short proximal landing zone, it was safe to patients underwent TEVAR and LSACSI, in which chimney stent could supply with enough blood flow to LSA, LVA and LAA. During TEVAR, iFlow technology used in one-step to assess the hemodynamic change of LSA was an efficient method and worthy to deeply debate for clinic doctors in terms of evaluating the efifciency and predicting the prognosis.%目的：在主动脉腔内修复术中对需要植入左侧锁骨下动脉支架的患者，应用iFlow技术即时评判在支架植入后对血流的影响，结合术后大血管CTA复查结果，综合判断左侧锁骨下动脉支架通畅率的影响因素。方法回顾性分析2013-01—2013-12北京安贞医院介入诊疗科收治的B型主动脉夹层患者214例，其中单纯行主动脉腔内修复术192例，行主动脉腔内修复术＋左侧锁骨下动脉支架植入术22例，使用iFlow软件分析患者术前及术后胸主动脉造影影像，分别在主动脉近弓处（主动脉支架前）、无名动脉起始处、左侧锁骨下动脉起始处、左侧椎动脉起始处及左侧腋动脉中段水平设置感兴趣区，采集参数包括ROI Area、ROI Peak/Ref Peak、ROI Peak Time、ROI AUC/Ref AUC，进行统计学分析。结果ROI Peak Time在主动脉腔内修复术植入和不植入左侧锁骨下动脉“烟囱”支架患者的各感兴趣区之间无明显差异。结论对锚定区较短的患者，在TEVAR术中并行左侧锁骨下动脉支架植入术是安全的，能够保证左侧锁骨下动脉、左侧椎动脉及左侧腋动脉血供；iFlow技术于术中即可以做到一站式评估TEVAR术中左侧锁骨下动脉支架的血流动力学改变，是一种辅助医生即时判断治疗效果及预测预后的有效方法，值得进一步探讨与推广。