Résumé
Objective To observe the effect of restrictive bare stent release on the distal end of Stanford type A aortic dissection.Methods From November 2016 to February 2018,20 patients with Stanford type A aortic dissection requiring aortic arch replacement and trunk surgery were selected for restrictive bare stent placement.Among them,there were 17 males and 3 females,aged 34-68 years old with an average age of(50.85 ± 8.49) years.The bare stent was released in the descending thoracic aorta,and the frozen elephant trunk was placed in the bare stent.The CTA of the great vessels was reviewed before discharge and the stent position and complications were observed.And compared with 42 patients with acute aortic arch replacement and stent-like nasal surgery in the acute Stanford type A aortic dissection from December 2013 to June 2015.Of the 42 patients,32 were males and 10 were females,aged 20-78 years,with an average of(49.36 ± 8.02) years.Results One patient in the bare stent group had greater resistance when the bare stent was placed,and the patient was disengaged and abandoned.The remaining 19 patients successfully completed the restrictive bare stent placement.One patient died of a large cerebral infarction during hospitalization.All 18 patients who survived and successfully placed the bare stent were followed up regularly.There was no stroke or death during the follow-up period.The computed tomography angiography of the computed tomography showed good shape and position,no displacement and type lⅢ endoleak,and no new fracture of the distal end of the elephant trunk was observed.In the conventional surgery group,2 patients died,1 patient died of large-scale cerebral infarction,and 1 patient died of perioperative myocardial infarction.No paraplegia cases.In 2 cases,a new rupture of the distal eud of the elephant trunk was performed,and the stent was placed again.Conclusion Compared with the conventional surgery group,the use of the restricted bare stent is safe,can effectively reduce the occurrence of stent-graft induced new entry and can significantly expand the diameter of the distal vessel,and the aortic remodeling effect is good.