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在TEVAR治疗期间左下关节动脉再血管化后,最佳的抗血小板治疗

Mengxiao Shi¹, Hong Fang¹, Ying Wu¹

¹Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Number 321 Zhong-shan Road, Nanjing, Jiangsu, 210008, China.

Journal of cardiothoracic surgery

|June 27, 2024

概括

单一抗血小板疗法 (SAPT) 降低了在接受胸腔内血管大动脉修复 (TEVAR) 与左关节下动脉 (LSA) 重建的患者的出血风险. 双重抗血小板疗法 (DAPT) 在六个月内增加出血事件,没有明显的缺血性益处.

科学领域:

心血管外科心血管外科
血管外科血管外科
干预心脏病学干预心脏病学

背景情况:

胸内血管大动脉修复 (TEVAR) 是B型大动脉解剖的微创治疗方法.
当剖析涉及LSA时,需要进行左下关节动脉 (LSA) 重建.
在LSA重建后,最佳的抗血小板治疗仍然不清楚.

研究的目的:

在TEVAR期间LSA重建后,比较单抗血小板治疗 (SAPT) 与双抗血小板治疗 (DAPT) 的安全性和有效性.
为了评估在接受TEVAR和LSA再血管化的患者中发生的出血和缺血事件.

主要方法:

对245名B型大动脉剖析患者的回顾性分析,这些患者接受了TEVAR与LSA再血管化.
患者被分为SAPT (阿司匹林) 和DAPT (阿司匹林加克洛皮多格雷尔) 组.
主要终点包括出血事件;次要终点包括半年内缺血事件,死亡和泄漏.

主要成果:

DAPT组显示出出血事件的发生率明显较高 (30.2%与8.2%相比).
在SAPT和DAPT组之间没有观察到缺血事件,死亡或泄漏的显著差异.
多变量分析确定了DAPT和慢性疾病是出血的危险因素;与化TEVAR相比,带下关节旁路和单分支支支架移植减少了缺血风险.

结论:

在接受TEVAR和LSA重建的患者中,SAPT显著降低了出血风险,在6个月内没有增加缺血事件.
患有先前存在的慢性疾病的患者面临更高的出血风险.
Carotid 关节下关节绕道和单分支支架支架移植与较低的缺血风险相关比 fenestration TEVAR.

关键词:

抗血小板药物可以抗血小板.动脉剖析是一个大动脉剖析.阿司匹林是一种阿司匹林.克洛皮多格雷尔的使用方法左下关节动脉复血管化治疗德瓦尔 (TEVAR) 是一个

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