摘要：

目的 探讨支架成形术治疗主动脉弓上血管近端狭窄的手术方法与疗效。方法与结果 2015 年 1 月至 2018 年 6 月采用支架成形术共治疗 13 例主动脉弓上血管近端狭窄患者，包括无名动脉狭窄 5 例、右侧颈总动脉狭窄 5 例、左侧颈总动脉狭窄 3 例，共植入 11 枚 Express LD 球囊扩张支架、2 枚Wallstent自膨式支架。其中，4 例患者支架释放过程中未使用保护伞（无名动脉狭窄 1 例、左侧颈总动脉狭窄 3 例），术后 3 d 1 例无名动脉狭窄患者 MRI 显示皮质小梗死；术后 6 个月 1 例无名动脉狭窄患者CTA 显示支架内再狭窄（狭窄率 > 50%）。结论 支架成形术治疗无名动脉和颈总动脉起始部狭窄安全、有效，围手术期和远期疗效满意。术中需重点关注导引导管稳定性和保护伞回收问题。

关键词: 主动脉, 胸, 血管成形术, 支架, 血管造影术, 数字减影

Abstract:

Objective To investigate the application of angioplasty and stenting in the treatment of proximal arcus aortae stenosis. Methods and Results From January 2015 to June 2018, 13 patients with proximal stenosis of superior aortic arch including 5 patients with anonymous stenosis, 5 patients with right common carotid artery (CCA) stenosis and 3 patients with left CCA stenosis were treated by stenting. Eleven Express LD balloon-expanding stents and 2 Wallstent self-expanding stents were implanted. No thrombus protective umbrella was used during stent release in 4 patients (one case of anonymous artery stenosis and 3 cases of left CCA stenosis). One case of anonymous artery stenosis showed small cortical infarction 3 d after operation. Six months after operation, CTA showed restenosis in stent in one case with anonymous artery stenosis. The restenosis rate was more than 50%. Conclusions Stenosis of anonymous artery and CCA can be treated by angioplasty and stenting. The stability of the guide catheter and the recovery of the filter devices should be considered during the operation. The perioperative and long-term results are satisfactory.

Key words: Aorta, thoracic, Angioplasty, Stents, Angiography, digital subtraction