Short-term Efficacy Of Castor Branch Stent Implantation And Chimney Technique In The Treatment Of TBAD Involving LSA

Objective: Comparison of Castor branch stent implantation and chimney technique in Stanford Type B aortic dissection(TBAD)involving Left subclavian artery(LSA),to further explore the advantages and disadvantages of Castor branch stent implantation versus the chimney technique,so provide the best surgical option for patients.Method: Patients aged 18 to 75 years old and regardless of gender were collected from Guilin People’s Hospital and Affiliated Hospital of Guilin Medical College from June 2018 to February 2022 who were finally diagnosed with TBAD involving LSA(aortic dissection with a distance of < 15 mm or >15mm from the LSA,but reverse tear involved LSA)through aortic CTA examination.The patients were divided into two groups according to different surgical procedures.Group A was the Castor branch stent implantation group(hereinafter referred to as the Castor group),which included 40 patients.Group B was the chimney technology group(hereinafter referred to as the chimney group),with 40 patients enrolled,and a total of 80 patients were enrolled in both groups.The basic information,clinical data during hospitalization,postoperative follow-up and other information of the two groups of patients were compared and counted.After repeated verification,all the data were input into Office Excel,and SPSS 26.0 statistical software was used to analyze the data.For the data listed in the paper,the measurement data was in the format of M±SD.Independent sample t test was used for comparison.Counting data were expressed as percentage and frequency,and were compared by chi-square test or,if necessary,by chi-square test with continuous correction.P<0.05 was considered statistically significant,with a confidence interval of 95%.Result: All patients successfully completed Castor branch stenting and chimney technology during the operation,and no surgery was transferred to open surgery during the operation.All patients were followed up for more than 1year after the operation,and no surgical intervention was performed again within 1 year after the operation,and no death occurred.In the Castor group,there was 1 case of cerebral infarction during hospitalization,1 case of incomplete thrombus in the pseudolumen 6 months and 12 months after surgery,and no branch artery stenosis or occlusion occurred within 1 year after surgery.The technical success rate was 97.5%;In the chimney group,there were 2 cases of postoperative leakage,3 cases of incomplete thrombus in the pseudolumen 6months after surgery,1 case of incomplete thrombus in the pseudolumen 12 months after surgery,and the remaining 2 cases of incomplete thrombus in the pseudolumen 12 months after surgery,1 patient showed branch artery stenosis 6months after surgery,branch artery was basically opened in the reexamination12 months after surgery,and 1 case of branch artery occlusion.After the treatment,the occlusion was still not opened in the reexamination 12 months after the operation,and the technical success rate was 95.0%.There was no special time from onset to operation in the two groups,and all patients received surgical treatment in the acute stage.The number of days after surgery and length of stay in Castor group was significantly shorter than that in chimney group(postoperative days: 11.7±2.4d vs 14.4±3.7d,p<0.05;Hospitalization days: 15.5d±2.4 vs 18.7±3.5d,p<0.05),but the operation time was longer than that of the chimney(2.4±0.9h vs 1.7±0.5h,p<0.05),and the difference between the two groups was statistically significant.The D-dimer level and WBC level of patients in 2 groups were higher than normal after admission,but decreased after operation compared with preoperative.Similarly,NLR of 2 groups after operation was decreased compared with preoperative,and there was no special difference between the two groups.Before surgery,both groups had smaller diameter of true cavity and larger diameter of false cavity;after treatment,the diameter of true cavity was significantly enlarged and the diameter of false cavity was significantly reduced;12 months after surgery and 6 months after surgery,the change of true cavity and false cavity was not obvious;both groups achieved good effect of aortic remodeling after surgery,and there was no significant difference between the two groups.Conclusion: 1.Castor branch stent implantation and chimney technique are both reliable,safe and effective surgical methods for the treatment of TBAD involving LSA.Both have good aortic remodeling effect and high technical success rate,but both may have adverse events.2.Castor branch stent implantation is associated with a shorter hospital stay than the chimney technique,which may lead to better short-term recovery,but an increased surgical duration,possibly due to the increased procedures and experience of the surgeon,which is expected to be further reduced in the future with increased surgical experience.3.When aortic dissection occurs,inflammatory indicators and D-dimer in patients may be increased to varying degrees,and decreased to varying degrees after surgery.This may be related to postoperative recovery of patients and prophylactic use of antibiotics.