新一代Captivia后释放输送系统Valiant主动脉覆膜支架使用初步体会

目的 初步评估Valiant Captivia主动脉覆膜支架在主动脉Stanford B型夹层主动脉腔内修复术（thoracic endovascular aortic repair,TEVAR）中应用的有效性及安全性.方法 收集从2012年1月至2012年6月在广东省人民医院住院,行Stanford B型主动脉夹层TEVAR,并使用Valiant支架传统输送系统或新一代Captivia输送系统的Valiant覆膜支架系统、病历资料完整的患者共40例.其中使用Valiant组25例,使用Captivia组15例.所有患者采用局部麻醉,经皮穿刺技术,使用快速右心室起搏进行起搏过程中控制性降压,通过造影进行支架定位.比较两组的移植物定位准确性、手术时间、内漏和并发症发生率等.结果 两组的基线资料包括年龄、性别及并发疾病、基础血压、支架释放时血压及介入后血压比较,差异无统计学意义（P＞0.05）.两组围术期心率包括基础、支架释放时,及介入治疗后心率和手术时间比较,差异无统计学意义（P＞0.05）.但从移植物定位准确性看,Captivia组与Valiant组相比较少产生移植物移位,差异有统计学意义[（4.9±2.4）mm vs.（3.3±1.8）mm,P=0.028].两组支架释放后即时造影发现残留内漏发生率及术后出现脊髓缺血的发生率比较,差异无统计学意义（P＞0.05）.结论 与原Valiant支架相比,新一代使用后释放设计的Valiant（R） Captivia支架释放时能更安全、简便地调整支架位置,有助于支架的精确释放.

Preliminary assessment of Valiant Captivia covered stent in thoracic endovascular aortic repair

Objectives To preliminary assess the efficacy and safety of Valiant Captivia covered stents in thoracic endovascular aortic repair（TEVAR） for Stanford type B aortic dissection （AD）.Methods The medical data of 40 patients with Stanford type BAD who received TEVAR from January 2012 to June 2012 in Guangdong General Hospital were collected and analyzed,including 25 cases using Valiant and 15 cases using Valiant Captivia stents.Local anesthesia,totally percutaneous puncture and rapid artificial cardiac pacing were applied to all these patients.Positioning accuracy,operation duration,endoleaks and complications were recorded and compared.Results Age,gender,comorbidities,blood pressures at baseline,when stents are releasing and after intervention,heart rates before operation,when stents are releasing and after intervention,and operation duration had no significant difference between the two groups （P＞0.05）.There were obviously less implant migration in Valiant Captivia group than in Valiant group [（4.9±2.4） mm vs.（3.3±1.8） mm,P=0.028].The rates of immediate endoleaks and spinal cord ischemia after procedure had no significant difference between the two groups （P＞0.05）.Conclusions Compared with the original Valiant covered stent,the latest Valiant（R） Captivia covered stent is more feasible to adjust the stent position and obtain a better positioning accuracy.