中文摘要：

目的总结应用限制性裸支架（restrictive bare stent，RBS）在主动脉夹层腔内治疗中的临床经验。方法回顾性分析第二军医大学附属长海医院2010年3月至2014年5月期间，行腔内治疗的Stanford B型主动脉夹层患者的临床资料。共356例病例纳入本研究。结果169例行经典主动脉夹层腔内隔绝术（thoracic endovascular aortic repair，TEVAR），187例行主动脉夹层腔内隔绝术＋限制性裸支架植入术（TEVAR4-RBS）。其中10例支架远端再发夹层（stent—graft induced distal redissection，SIDR）。术前不匹配率（覆膜支架远端15径／术前该水平夹层真腔长径）〉120％的患者SIDR发生率高于术前不匹配率≤120％的患者（4．0％和0％）；选用RBS的放大率（RBS口径／术前该水平夹层真腔长径）为100％-120％的病例SIDR发生率低于放大率〉120％的病例（0％和3．7％）。当腔内移植物口径与主动脉管腔相匹配时，可降低SIDR发生率（0％和3．9％，P〈0．05），并减少再次腔内治疗的发生率（2．4％和8．2％，P〈0．05）。结论腔内移植物口径与夹层真腔长径不匹配是SIDR的主要危险因素，RBS使用指征及其15径选择标准的把握是降低SIDR发生率的关键。

英文摘要：

Objective To analyze the clinical outcomes of type B aortic dissection patients treated with restrictive bare stent （RBS） for thoracic endovascular aortic repair （TEVAR）. Methods A retrospective analysis was made on clinical outcomes for 356 patients admitted from March 2010 to May 2014 with Stanford type B aortic dissection treated by TEYAR. Results 169 patients were treated by classic TEVAR, and 187 patients received endovascular repair of TEVAR ＋ RBS. 10 patients had stent-graft induced distal re-dissection （ SIDR ） . The morbidity of SIDR were higher in the group of preoperative mismatch rate 〉 120% , than those of preoperative mismatch rate ≤120% （4. 0% vs 0% ） ; and that was higher in the group the oversizing 〉 120% than that the oversizing were between 100% - 120% （0% vs 3.7% ）. When the caliber of stent-graft matched the true lumen of dissection, the morbidity of SIDR significantly reduced （0% vs 3.9%, P 〈 0. 05 ）, and also of the re-intervention of endovascular treatment （2. 4% vs 8.2%, P 〈 0. 05 ）. Conclusions The mismatch between the caliber of stent-graft and the true lumen maximum diameter of aortic dissection is a major risk factor for SIDR. The key to reduce the morbidity of SIDR is to grasp the indications and caliber selection criteria in the use of RBS.