CAJ | 학술논문

主动脉弓解剖分型对颈动脉支架置入术技术指标的影响
주동맥궁해부분형대경동맥지가치입술기술지표적영향
Effect of Aortic Arch Type on Technical Indicators in Patients With Carotid Artery Stent Implantation

万方数据

中国循环杂志中國循環雜誌 중국순배잡지
CHINESE CIRCULATION JOURNAL
2015年 1期 34-37 ,共4页

沈松鹤%蒋雄京%董徽%彭猛%王志学%邹玉宝%刘亚欣%宋雷%张慧敏%吴海英

침송학%장웅경%동휘%팽맹%왕지학%추옥보%류아흔%송뢰%장혜민%오해영

颈动脉支架置入术%主动脉弓形态%Myla分型頸動脈支架置入術%主動脈弓形態%Myla分型
경동맥지가치입술%주동맥궁형태%Myla분형
Carotid artery stent implantation%Aortic arch type%Myla classiifcation

目的：探讨主动脉弓解剖分型对颈动脉支架置入术技术指标的影响。 　　方法：回顾性分析2011-01至2012-12阜外心血管病医院连续224例单侧颈动脉支架置入术资料。记录颈动脉支架置入术中插入颈动脉的导管类别及型号、操作技术（1.回撤翻转直接插入；2.回撤翻转+导丝引导；3.回撤翻转+导丝引导+子导管支撑；4.特殊造影导管+导丝引导+子母导管）、操作X线曝光时间、对比剂用量及操作相关并发症。主动脉弓解剖按Myla分型分为I、II、III三型。 　　结果：224例患者I型弓7例（3.1%），II型弓113例（50.4%），III型弓104例（46.4%）。104例III型弓有48例（46.2%）患者使用特殊技术（技术3、4），比I型弓1例（14.3%）、II型弓17例（14.9%）明显增高（P<0.05）；III型主动脉弓患者较I型弓、II型弓患者在曝光时间、使用对比剂量及操作失败率方面均明显增多（P均<0.05）；III型弓患者手术成功率（96.2%）低于I型弓（100%）、II型弓（100%）患者（P<0.05）。操作相关并发症：III型弓患者中并发症总计发生率（22.1%）高于I型弓（0）、II型弓（8.9%）患者（P<0.05）。 　　结论：主动脉弓形态是影响颈动脉支架置入术技术指标的重要因素，III型弓使颈动脉支架置入术的难度增加，并发症增多。
목적：탐토주동맥궁해부분형대경동맥지가치입술기술지표적영향。 　　방법：회고성분석2011-01지2012-12부외심혈관병의원련속224례단측경동맥지가치입술자료。기록경동맥지가치입술중삽입경동맥적도관유별급형호、조작기술（1.회철번전직접삽입；2.회철번전+도사인도；3.회철번전+도사인도+자도관지탱；4.특수조영도관+도사인도+자모도관）、조작X선폭광시간、대비제용량급조작상관병발증。주동맥궁해부안Myla분형분위I、II、III삼형。 　　결과：224례환자I형궁7례（3.1%），II형궁113례（50.4%），III형궁104례（46.4%）。104례III형궁유48례（46.2%）환자사용특수기술（기술3、4），비I형궁1례（14.3%）、II형궁17례（14.9%）명현증고（P<0.05）；III형주동맥궁환자교I형궁、II형궁환자재폭광시간、사용대비제량급조작실패솔방면균명현증다（P균<0.05）；III형궁환자수술성공솔（96.2%）저우I형궁（100%）、II형궁（100%）환자（P<0.05）。조작상관병발증：III형궁환자중병발증총계발생솔（22.1%）고우I형궁（0）、II형궁（8.9%）환자（P<0.05）。 　　결론：주동맥궁형태시영향경동맥지가치입술기술지표적중요인소，III형궁사경동맥지가치입술적난도증가，병발증증다。
Objective: To explore the effect of the aortic arch type on technical indicators in patients with carotid artery stent implantation. Methods: We retrospectively analyzed 224 consecutive patients treated in Fu Wai hospital for unilateral carotid artery stent implantation from 2011-01 to 2012-12. We summarized the catheter category, type and the operating techniques including ① retracement, turn and insertion of the catheter, ② retracement, turn of catheter+the guidance of guide wire,③ retracement, turn of catheter+the guidance of guide wire+the supporting of another catheter, ④ using special graphic catheter+the guidance of guide wire+the supporting of another catheter. The procedural X-ray exposure time, dosage of contrast agent and operation related complications were recorded. According to Myla classiifcation, the aortic arches were divided into Myla I, Myla II and Myla III types. Results: There were 7/224 (3.1%) patients with Myla I aortic arch, 113 (50.4%) with Myla II aortic arch and 104 (46.4%) with Myla III aortic arch. A total of 48/104 (46.2%) Myla III patients used special techniques (tech③, tech④), it was more than the patients with Myla I, (1/7,14.3%) and Myla II (17/113, 15.0%), P<0.01. The patients with Myla III aortic arch had the longer X-ray exposure time and used the higher dose of contrast agent, all P<0.01. The procedural success rate in patients with Myla III was 96.2%, it was lower than those with Myla I (100%) and Myla II (100%), P=0.045. The procedural complication rate in patients with Myla III was 22.1%, it was higher than those with Myla I (0%) and Myla II (8.9%), P=0.007. Conclusion: The aortic arch type is the important inlfuential factor for the techniques used in carotid stent implantation. There were more dififculties and complications for stent implantation in patients with Myla III aortic arch.