不同腔内技术治疗非A非B型夹层的神经系统并发症研究进展

doi:10.6040/j.issn.1671-7554.0.2024.0268

摘要/Abstract

摘要： 非A非B型主动脉夹层是一种危重症心血管疾病,往往需要早期积极的干预治疗。因其累及主动脉弓部重要分支,易造成神经系统并发症。目前对非A非B型夹层腔内治疗方式的选择尚未达到统一,其主要的腔内技术主要包括烟囱技术、开窗技术和分支支架技术。本文从术后引起神经系统并发症方面对不同腔内技术治疗非A非B型夹层进行综述,发现开窗技术可能与较低的围术期脑卒中并发症发生率相关,烟囱技术与较低的围术期脊髓缺血并发症发生率相关。当主动脉弓部分支重建置入的支架数量增加时,脑卒中发生率也随之升高。在与手术相关的神经系统并发症方面,开窗、烟囱技术联合血管腔内修复非A非B型夹层的治疗方式可能有部分优势,但这些结论仍需要大样本数据进行验证。此外,非A非B型主动脉夹层围手术期神经系统并发症与多种因素相关,其确切机制尚未完全明确,相关危险因素和预防措施对预后的影响有待进一步深入研究。

关键词: 主动脉夹层, 非A非B型, 胸主动脉腔内修复术, 开窗, 脑卒中

Abstract: Non-A non-B aortic dissection is a critical cardiovascular condition that often requires early and aggressive intervention. Due to its involvement of major branches of the aortic arch, it frequently leads to neurological complications. Currently, there is no consensus on the optimal endovascular treatment for non-A non-B aortic dissection. The main endovascular techniques include the chimney technique, fenestration technique, and branched stent grafts. This paper reviews the use of these techniques in relation to postoperative neurological complications. It was found that various fenestration techniques may be associated with a lower incidence of perioperative stroke, while the chimney technique may reduce the incidence of perioperative spinal cord ischemia. The number of stents implanted for aortic arch branch reconstruction is positively correlated with the incidence of stroke. With regard to surgery-related neurological complications, fenestration or chimney technology combined with endovascular repair for non-A non-B aortic dissections may have some advantages, but these conclusions still need to be validated with large sample data. Moreover, the perioperative neurological complications of non-A non-B aortic dissection are related to multiple factors, and the exact mechanism of which has not yet been fully elucidated. Furthermore, the impact of related risk factors and preventive measures on prognosis requires further in-depth investigation.

Key words: Aortic dissection, Non-A non-B, Thoracic endovascular aortic repair, Fenestration, Cerebral stroke

中图分类号:

R654.3

李晨淑,王瑞华,陆信武. 不同腔内技术治疗非A非B型夹层的神经系统并发症研究进展[J]. 山东大学学报 (医学版), 2024, 62(11): 1-7.

LI Chenshu, WANG Ruihua, LU Xinwu. Research progress in neurological complications of non-A non-B aortic dissection treated with different endovascular techniques[J]. Journal of Shandong University (Health Sciences), 2024, 62(11): 1-7.

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