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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。
Objective: To investigate the effect of aortic arch anatomy on the technical indexes of carotid artery stenting. Methods: A retrospective analysis of 224 patients with unilateral carotid stenting at Fu Wai Hospital from 2011 to 2012 was conducted. Record carotid artery stenting into the carotid artery catheterization category and type of operation technique (1. retraction flip directly into; 2. retraction flip + guide wire guide; 3. retraction flip + guide wire guide + sub-catheter Support; 4. Special contrast catheter + guide wire guide + parent catheter), operation X-ray exposure time, contrast agent dosage and operation-related complications. Aortic arch anatomy according to Myla classification is divided into Ⅰ, Ⅱ, Ⅲ Ⅲ type. Results: In the 224 cases, type Ⅰ arch was found in 7 cases (3.1%), type Ⅱ arch in 113 cases (50.4%) and type Ⅲ arch in 104 cases (46.4%). 48 cases (46.2%) of 104 cases with type Ⅲ arch were significantly higher than those with type Ⅰ arch in 1 case (14.3%) and type Ⅱ arch (17 cases) (14.9%) (P <0.05) ; Type Ⅲ aortic arch patients than type Ⅰ and type Ⅱ bows in the exposure time, the use of contrast dose and failure rate were significantly increased (all P <0.05); type Ⅲ arch surgery patients with success rate (96.2%) lower than Ⅰ (100%) and type II (100%) patients (P <0.05). Operation-related complications: The overall complication rate was higher in type Ⅲ patients (22.1%) than in patients with type Ⅰ (0) and type Ⅱ (8.9%) patients (P <0.05). CONCLUSION: Aortic arch morphology is an important factor influencing the technical indexes of carotid artery stenting. The difficulty of stenting of carotid stenting with type Ⅲ arch increases and the complication increases.