中国普通外科杂志2025，Vol.34Issue(12)：2577-2585,9.DOI:10.7659/j.issn.1005-6947.250429
应用Castor分支型支架联合无名动脉烟囱技术行Z0区TEVAR的初步临床研究
Preliminary clinical experience of zone 0 TEVAR using a Castor branched stent-graft combined with the innominate artery chimney technique
摘要
Abstract
Background and Aims:Thoracic endovascular aortic repair(TEVAR)has become an important minimally invasive treatment for thoracic aortic diseases.However,management of complex aortic arch lesions requiring a proximal landing zone in zone 0(Z0)remains technically challenging due to the need for supra-aortic branch reconstruction.The Castor single-branched stent-graft enables integrated reconstruction of the left common carotid artery(LCCA),but its application in Z0 TEVAR often necessitates adjunctive techniques for innominate artery(IA)revascularization.This study aimed to preliminarily evaluate the technical feasibility and short-term outcomes of Z0 TEVAR using a Castor branched stent-graft for LCCA reconstruction combined with an IA chimney stent. Methods:Patients with aortic pathologies who underwent Z0 TEVAR using a Castor branched stent-graft for LCCA reconstruction combined with an IA chimney stent at the Second Xiangya Hospital of Central South University between February and June 2024 were retrospectively reviewed.Perioperative data and follow-up outcomes were analyzed.Primary endpoints included technical success,perioperative complications,and patency of reconstructed supra-aortic branches.Concomitant left subclavian artery(LSA)revascularization was determined on an individualized basis according to preoperative imaging findings. Results:Six patients(mean age 51.5 years;5 males)were included,with underlying pathologies comprising aortic dissection(n=4),aortic arch aneurysm(n=1),and penetrating aortic ulcer(n=1).All procedures were successfully completed,yielding a technical success rate of 100%.Concomitant LSA revascularization was performed in three patients.No mortality,stroke,spinal cord ischemia,endoleak,retrograde type A aortic dissection,stent migration,or upper extremity ischemia occurred within 30 days postoperatively.During a median follow-up of 13 months(range,11-15 months),no major adverse cardiovascular or cerebrovascular events or stent-related complications were observed.Imaging follow-up demonstrated 100%patency of the IA,LCCA,and reconstructed LSA. Conclusion:In a small,carefully selected cohort,Z0 TEVAR using a Castor branched stent-graft for LCCA reconstruction combined with an IA chimney stent is technically feasible and associated with favorable short-term branch patency.Further studies with larger sample sizes and longer follow-up are required to validate its safety and long-term efficacy.关键词
主动脉疾病/Castor分支型支架/烟囱支架技术/血管内操作Key words
Aortic Diseases/Castor branched stent/Chimney Technique/Endovascular Procedures分类
医药卫生引用本文复制引用
张雷,李睿,李全明,黎明,何昊,夏德芗,李鑫,舒畅..应用Castor分支型支架联合无名动脉烟囱技术行Z0区TEVAR的初步临床研究[J].中国普通外科杂志,2025,34(12):2577-2585,9.基金项目
国家自然科学基金资助项目(82120108005) （82120108005）
中南大学研究生自主探索创新基金资助项目(2022XQLH153). （2022XQLH153）
