Analysis And Evaluation Of Castor Stent And Chimney Stent In Reconstruction Of Left Subclavian Artery

ObjectiveTo summarize and analyze the experience of castor single branch stent and single chimney stent in the reconstruction of the left subclavian artery in the treatment of thoracic aortic disease.MethodThe clinical data of 42 patients admitted to our hospital from December 2015 to June2019 due to thoracic aortic aneurysm,thoracic aortic dissection,thoracic aortic ulcer,thoracic aortic intermural hematoma and other thoracic aortic diseases were retrospectively analyzed.Among the 42 patients,19 patients were treated with Castor single-branch stent,including 13 patients with Stanford type B aortic dissection,5 patients with thoracic aortic aneurysm,and 1 patient with thoracic aortic ulcer;23 patients were treated with the single-stack stent technique,including 14 Stanford type B aortic dissection patients,7thoracic aortic aneurysm patients,and 2 thoracic aortic ulcer patients.The data of various indicators and imaging results of patients receiving different types of stents during perioperative period and postoperative follow-up period were analyzed and compared between the two groups,especially the postoperative aortic diameter,stent patency and stent leakage,etc.ResultsThe success rate of Castor stent and chimney stent was 100% and there were no death,stroke or paraplegia patients.The mean operative time for patients in the Castor single-branch stent group was(101.1±8.4)min and the mean operative time for patients in the single-stack stent group was(127.8±8.7)min.The mean length of hospital stay for patients in the Castor single-branch stent group was(9.6±1.7)days compared with(9.6±1.6)days for patients in the single-stack stent group.Among the 19 patients in the Castor branch stent group,1 patient developed Ⅰ type leakage after surgery.Among the 23 patients in the stent group,7 patients developed Ⅰ type internal leakage.No stent patients died during the follow-up in both groups.Patients in the Castor branched stent group were followed up for(18.9±5.9)months,with a branched stent patency rate of 100%,and patients in the chimney stent group were followed up for(15.5±8.7)months,with a chimney stent patency rate of91.3%.At 6 months and 1 year after surgery,the diameter of the aortic false lumen and the diameter of the true lumen in the Castor single-branch stent group were significantly reduced,and the changes were more obvious than those in the single-chimney stent group.The probability of complete aortic thrombosis in Castor group(84.2%)was significantly higher than that in chimney group(65.2%).The Angle of the left subclavian artery in the Castor single-branch stent group was(55.1±10.6)°,which was significantly higher than that in the single-chimney stent group(37.2±6.0)°.ConclusionBoth Castor single-branch stent and single-chimney stent can be used to treat a variety of thoracic aortic diseases requiring remodeling of the left subclavian artery due to insufficient proximal anchoring area,and the patency rate and incidence of leakage of the stent were satisfactory during the near and middle postoperative follow-up.When the Angle of the left subclavian artery was between 0 and 40°,there was no significant difference in the incidence of stent leakage between the two groups.However,when the Angle of the left subclavian artery was greater than 40°,the incidence of stent leakage in the Castor single-branch stent group was significantly lower than that in the single-chimney stent group.There was no significant correlation between Castor single-branch stenting and left subclavian artery angulation(P > 0.05),but there was a significant positive correlation between single-chimney stenting and left subclavian artery angulation(P < 0.05).In other words,the greater the angle of left subclavian artery angulation,the more likely the leakage was to occur after single-chimney stenting.The requirement of Castor stent for left subclavian artery angulation is low,and the probability of complete thrombosis of the false cavity is high after surgery.For patients with large angulation of left subclavian artery,Castor stent can be given priority,and the long-term effect of the two groups of stent patients after surgery remains to be followed up and observed.