Endovascular Repair of Stanford B-type Thoracic Aortic Dissection With Insufficient Proximal Landing Zone by Left Subclavian Artery in Situ Stent Graft Puncture and Fenestration: A Prospective, Single-arm, Observational Clinical Trial.
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 217
- 试验地点
- 1
- 主要终点
- Patency rate of main and branch stent.
研究概览
简要总结
Background: Aortic dissection (AD) is a common emergency in vascular surgery, which seriously threatens human life and health. The rupture of Stanford type B dissection is located in aortic arch and the dissection range is from the descending aorta or involves the abdominal aorta. At present, the endovascular repair of the thoracic aorta (TEVAR) for AD has been widely deployed worldwide and has become the standard surgical procedure for the treatment of AD. However, there is still controversy regarding the Stanford B aortic dissection that involves the left subclavian artery or the stent landing area less than 1.5 cm.
Study objective: To evaluate the effectiveness and safety of endovascular repair with in situ needle fenestration of left subclavian artery.
Methods: This study intends to enroll 217 patients with Stanford type B aortic dissection who meet the enrollment criteria. The patients will be followed up at 1, 6, 12, and 24 months after endovascular repair, and the CTA images of the thoracic aorta were collected.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 85 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Based on Computed Tomography Angiography, it is clearly diagnosed as Stanford B type aortic dissection with a breach close to the left subclavian artery;
- •The dissection the left subclavian artery, and the proximal landing area is less than 1.5cm. The proximal end of the stent needs to be anchored in zone 2 and the left subclavian needs to be performed arterial revascularization;
- •Landing area requirements: no dissection, no intermural hematoma, no severe calcification, no aneurysm-like expansion, diameter 21-44mm, distance between left common carotid artery and left subclavian artery≥10mm;
- •The puncture in situ fenestration technique was used to reconstruct the left subclavian artery;
- •Signed informed consent;
- •Age ≥18 years old, ≤85 years old, no gender limit.
排除标准
- •Combined ascending aorta disease or performed ascending aorta surgery before;
- •Congenital connective tissue disease (Marfan syndrome, etc.);
- •Patients with renal failure or chronic kidney disease before endovascular repair(eGFR≤30ml/min, Dialysis needed, serum creatinine ≥2.5mg/mL within 30 days before operation);
- •Cerebral hemorrhage, symptomatic cerebral infarction within 6 weeks before treatment, myocardial infarction within 6 weeks before treatment;
- •Combined systemic diseases that cannot be controlled by current medical level (Such as severe heart function, lung function or liver function abnormalities, patients with advanced tumors, patients with cachexia, severe coronary heart disease symptoms that cannot be relieved, abnormal blood coagulation caused by genetic diseases, etc.) ；
- •Patient under 18 years or older than 85 years;
- •The life expectancy of the patient is shorter than 2 years;
- •Those suffering from mental illness or subjectively unable to cooperate;
- •Women who are breastfeeding or pregnant, or women or men who have recently had a childbirth plan;
- •Currently participating in other interventions research or patients who have been enrolled in this study;
- •Have a history of aortic or left subclavian artery surgery;
- •Active systemic infection or uncontrolled coagulation dysfunction within 14 days before treatment;
- •Those who are unable to take the medication as required by the protocol, or are allergic to antiplatelet drugs (aspirin or clopidogrel), low molecular weight heparin or contrast agents;
- •Type II heparin-induced thrombocytopenia (HIT-2) or known hypersensitivity to heparin;
- •Thoracic aortic aneurysm, pseudoaneurysm, simple thoracic aortic transmural ulcer, thoracic aortic intermural hematoma;
- •There are prominent or irregular thrombus and/or atheroma in the aortic arch or ascending aorta;
- •The iliac artery or femoral artery approach is severely diseased and the stent cannot be passed;
- •The left subclavian artery is occluded or left Those who have no suitable access for the upper extremities;
- •The left subclavian artery is abnormally twisted or angled and is not suitable for fenestration;
- •Other conditions that the investigator judges are not suitable for enrollment.
结局指标
主要结局
Patency rate of main and branch stent.
时间窗: 24 months after interventional therapy
Patency of main and branch stent will be evaluated by Computed Tomography Angiography.
次要结局
未报告次要终点