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目的:探讨胸主动脉腔内修复术（TEVAR）联合原位激光开窗（ISLF）处理主动脉弓部病变的有效性和安全性，并分析通过鞘临时转流系统在术中维持脑灌注的临床结果。方法:回顾性分析2017年1月至2019年12月在上海交通大学医学院附属第九人民医院接受TEVAR联合ISLF完成了累及主动脉弓部病变的腔内修复术并应用血管鞘进行弓上动脉临时转流维持脑灌注的61例患者的临床资料，包括Stanford A型夹层25例，Stanford B型夹层8例，壁间血肿9例，透壁性溃疡5例及主动脉瘤14例。评估手术成功率、主动脉重塑情况、分支支架通畅情况、神经系统并发症发生率。结果:61例患者中，47例行弓上三分支开窗重建，14例行两分支开窗重建，技术成功率为100%。3例（4.9%）患者出现术后一过性卒中症状，无严重卒中事件。无截瘫，在院期间死亡1例，死因为急性心肌梗死。60例患者获得随访，随访时间为（21.8 ± 10.4）个月。12个月随访中死亡3例，其中1例死因为急性心肌梗死，1例为急性心力衰竭，1例为重症肺炎。术后12个月共55例患者行主动脉CTA复查，其中52例主动脉弓部重塑良好，表现为主动脉支架覆盖区域的假腔或瘤腔内血栓化；3例患者存在内漏；弓上分支动脉均通畅，无急性血栓形成及慢性支架内再狭窄。无截瘫及卒中病例。结论:TEVAR联合ISLF是治疗复杂主动脉弓部病变安全且有效的方法，技术成功率高，早期预后良好；术中血管鞘临时转流系统的应用可有效进行脑保护、降低卒中发生率。“,”Objective:To investigate the efficacy and safety of thoracic endovascular aortic repair (TEVAR) combined with in-situ laser fenestration (ISLF) in the treatment of aortic arch lesions and analyze the clinical outcomes of maintaining cerebral perfusion during operation by temporary sheath-based bypass system.Methods:From January 2017 to December 2019, clinical data of 61 patients who underwent TEVAR combined with ISLF in the Shanghai Ninth people\'s Hospital Affiliated to Shanghai Jiaotong University School of Medicine to receive endovascular repair involving aortic arch lesions, and maintain cerebral perfusion through temporary shunt applied to supra-aortic artery by using vascular sheathwere retrospectively analyzed, including 25 cases of Stanford type A aortic dissection, 8 cases of Stanford type B aortic dissection, 9 cases of intramural hematoma, 5 cases of penetrating ulcer, and 14 cases of aortic aneurysm. The technical success rate, aortic remodeling, patency of branch stents, and incidence of neurological complications were evaluated.Results:Among 61 patients, 47 cases underwent fenestration and reconstruction of three supra-aortic branches, and 14 cases of two branches, with a technical success rate of 100%. 4.9% of the patients (3/61) had transient stroke symptoms after operation. One case died due to acute myocardial infarction during hospitalization. Sixty patients were followed up for ( 21.8±10.4 ) months. There were 3 new deaths during the 12-month follow-up, 1 due to acute myocardial infarction, 1 due to acute heart failure, and 1 due to severe pneumonia. A total of 55 patients received reviews of CTA of aorta 12 months after operation. Among them, 52 patients had complete aortic arch remodeling, presented as false lumen or intratumoral thrombosis in the area covered by aortic stents. Endoleaks were observed in 3 patients. No acute thrombosis and chronic in-stent restenosis happened in any supra-aortic branch stents. There were no new cases of paraplegia and stroke.Conclusion:TEVAR combined with ISLF is a safe and effective method for the treatment of complex aortic arch lesions, with a high technical success rate and good early prognosis. The application of temporary sheath-based bypass system can effectively protect brain and reduce the incidence of stroke.