CN112603614A - Modular aortic arch part covered stent - Google Patents

Abstract

The invention provides a modular aortic arch part covered stent, which relates to the field of medical instruments and comprises a main body covered stent and modular branch stents, wherein the main body covered stent is provided with a plurality of stent struts; the main body covered stent comprises a framework and a covered membrane, wherein windows are arranged on the covered membrane corresponding to three branches of the aortic arch part blood vessel of a patient, and developing markers are arranged on the edges of the windows; the modularized branch stent comprises a main stent and a branch covered stent connected to the side portion of the main stent, a root covered membrane is arranged at the position where the main stent is connected with the branch covered stent, adjacent blood vessel avoiding grooves are formed in the near end and/or the far end of the position, located on the main stent, of the root covered membrane, and developing markers are arranged on the edges of the adjacent blood vessel avoiding grooves. The invention solves the technical problem that the existing tectorial membrane bracket in the prior art is not beneficial to the application of minimally invasive endovascular intervention isolation operation on the aortic arch.

Description

Modular aortic arch part covered stent

Technical Field

The invention relates to the field of medical instruments, in particular to a modular aortic arch part covered stent.

Background

The aortic disease is a group of cardiovascular diseases seriously threatening human health, including aortic dissection, aortic aneurysm and the like, mainly caused by hypertension, arteriosclerosis, injury, infection and other reasons, has great threat to the life of a patient, especially has wide range of pathological changes, influences the aortic dissection of brain, spinal cord and multi-organ blood supply, has large operation wound, complicated operation, long time, much blood consumption, and high complication incidence rate and operation death rate of the operation. The reconstruction of the blood supply of the aorta and its branch arteries in as short a time as possible has always been the goal sought by vascular surgeons.

The diseased position of the aortic dissection is a core factor for determining the operation mode, the B-type dissection or aneurysm with a broken opening positioned in descending aorta usually adopts the aortic intracavity repair technology with small wound and high success rate, the delivery system loaded with the covered stent is pushed to the diseased part through the aorta far end such as a femoral artery incision of a human body, the covered stent is released and fixed, the diseased aneurysm or the dissection is isolated, and a blood transport channel is reconstructed, so that the treatment purpose is achieved. However, when the aortic arch with openings of the brachiocephalic trunk, the left common carotid artery and the left subclavian artery is affected by the interlayer, since branch blood vessels are involved and the difference of physiological debridement structures of patients is large, if minimally invasive endovascular intervention isolation surgery is adopted, the existing covered stent can block the branch arteries to different degrees, so that blood flow of the branch arteries is obstructed, corresponding complications occur and even life can be endangered, and if a windowing, chimney stent and other branch reconstruction technologies are adopted, the operation is complex and internal leakage is easy to occur.

Specifically, since each patient has 3 branch vessels emanating from the aortic arch: the unknown artery, the left common carotid artery and the left subclavian artery have different traveling, and the distances among the openings of the three branch blood vessels, the arrangement angles and the thicknesses of the branch blood vessels are different, so that the shape of the combined bow-shaped blood vessel with three branches is greatly different, and different bow-shaped blood vessels cannot be completely matched through one prefabricated bracket. Once the stent is not matched to the vessel, intraluminal repair therapy cannot be completed. The tectorial membrane support that present arcus blood vessel's intracavity intervenes treatment technique adopted mainly includes customization support, chimney technique, windowing technique and single branch support, to the customization support, needs to customize aorta branch support very much according to the concrete anatomical conditions of patient, requires when implanting aorta branch blood vessel aorta pathological change position to aim at the branch artery with its side opening simultaneously, guarantees that branch artery blood flow is unobstructed, implants the little support in the branch artery again. However, this method has the following disadvantages: the stent is specially customized according to the specific anatomical conditions of the patient, the cost is high and the mass production cannot be realized; the customized bracket takes longer time and cannot be used for emergency operation patients; the operation is complex, each side hole is required to be respectively and accurately aligned to the involved branch artery when the stent is released, if deviation exists, the blood flow of the branch artery can be obstructed, corresponding complications can occur, and the life can be threatened when the deviation is serious. The chimney technology ensures the unobstructed branch blood vessels by arranging a parallel naked stent or a covered stent in the covered branch blood vessels, so that the proximal end opening of the branch blood vessels is extended to the front of the aorta covered stent, and the proximal end anchoring area of the aorta covered stent is prolonged. However, the gap exists between the branch bracket and the main bracket, so that internal leakage is easy to generate; the windowing technology comprises external windowing and in-vivo in-situ windowing, the original complete straight cylinder support is transformed, the operation is complex, the technical requirement on a clinician is high, and certain risks exist. Single branch stents can only address reconstruction of one branch at present due to individualized differences in vessels.

The above all limit the application of minimally invasive endovascular intervention isolation surgery to the aortic arch with dissection affected by the brachiocephalic trunk, left common carotid artery and left subclavian artery openings.

Disclosure of Invention

The invention aims to provide a modular aortic arch part covered stent, which solves the technical problem that the existing covered stent in the prior art is not beneficial to applying a minimally invasive endovascular intervention isolation operation to an aortic arch.

In order to achieve the above purpose, the embodiment of the invention adopts the following technical scheme:

the embodiment of the invention provides a modular aortic arch part covered stent, which comprises a main body covered stent and modular branch stents, wherein the main body covered stent is provided with a stent core;

the main body covered stent comprises a framework and a covering film; a window is arranged on the covering film corresponding to the position of three branches of the aortic arch part blood vessel of the patient, and the edge of the window is provided with a developing marker;

the modularized branch stent comprises a main stent and a branch tectorial membrane stent connected to the side part of the main stent, wherein the main stent and the branch tectorial membrane stent are both formed into a cylinder shape, a root tectorial membrane is arranged at the connecting part of the main stent and the branch tectorial membrane stent, adjacent blood vessel avoiding grooves are arranged at the near end and/or the far end of the part of the root tectorial membrane, which is positioned on the main stent, and developing markers are arranged at the edges of the adjacent blood vessel avoiding grooves;

the modular branch stent is configured to be connected to the main body stent graft in a manner that the main stent graft is sleeved inside the main body stent graft and the branch stent graft extends out of the window.

In an optional embodiment, the framework comprises a left annular supporting framework, a right annular supporting framework and a plurality of longitudinal beams connecting the left annular supporting framework and the right annular supporting framework, and the film covering is connected to the outer circumferential surface of the framework and extends from the left annular supporting framework to the right annular supporting framework; the framework is integrally bent into an arch shape adapted to the aortic arch of a patient, and the window is arranged on the part, corresponding to the longitudinal beams, of the film.

In an alternative embodiment, the module leg support comprises a first module support, a second module support, and a middle module support;

the telecentricity of the root tectorial membrane of first modular support the nearly heart end of the root tectorial membrane of second modular support the nearly heart end of the root tectorial membrane of middle part modular support and the telecentricity of the root tectorial membrane of middle part modular support has all been seted up adjacent blood vessel and has been dodged the groove.

In an alternative embodiment, the module branch support comprises a first module support and a middle module support;

the far end of the root covering film of the first modular bracket, the near end of the root covering film of the middle modular bracket and the far end of the root covering film of the middle modular bracket are all provided with the adjacent blood vessel avoidance grooves; and a part of the main body covered stent, which is close to the window, is connected with a branch stent.

In alternative embodiments, the adjacent blood vessel avoidance slots are C-shaped or U-shaped.

In an alternative embodiment, the main stent is a covered stent, and the root covering membrane and the covering membrane of the main stent are the same covering membrane; or the main stent is a bare stent, and the root tectorial membrane is a tectorial membrane patch.

In an alternative embodiment, the graft patch is connected to the graft of the branched graft stent.

In an alternative embodiment, in the modular branch stent, an included angle between the axial direction of the main stent and the axial direction of the branch stent graft is 70-110 degrees.

In an alternative embodiment, the visualization marker of the edge of the adjacent blood vessel avoidance groove is gold wire.

In an alternative embodiment, the developing marker at the edge of the window has a plurality of developing markers, and the plurality of developing markers are arranged along the edge of the window at intervals in pairs to form a plurality of developing marker points.

The embodiment of the invention can realize the following beneficial effects:

the embodiment of the invention provides a modular aortic arch part covered stent which comprises a main body covered stent and modular branch stents. Wherein: the main body covered stent comprises a framework and a covering film; a window is arranged on the covering film corresponding to the position of three branches of the aortic arch part blood vessel of the patient, and the edge of the window is provided with a developing marker; the modularized branch stent comprises a main stent and a branch tectorial membrane stent connected to the side part of the main stent, wherein the main stent and the branch tectorial membrane stent are both formed into a cylinder shape, a root tectorial membrane is arranged at the connecting part of the main stent and the branch tectorial membrane stent, adjacent blood vessel avoiding grooves are arranged at the near end and/or the far end of the part of the root tectorial membrane, which is positioned on the main stent, and developing markers are arranged at the edges of the adjacent blood vessel avoiding grooves; "and/or" means that the proximal end and the distal end of the part of the root tectorial membrane, which is positioned on the main stent, are provided with adjacent blood vessel evasion grooves alternatively or simultaneously; the modular branch stent is configured to be connected to the main body covered stent in a manner that the main stent is sleeved inside the covering membrane of the main body covered stent and the branch covered stent extends out of the window.

When implanting, under the cooperation of development marker and X ray, utilize the implantation device to implant main part tectorial membrane support in the aorta earlier, and make the window correspond to patient's aortic arch portion blood vessel three branch positions, then implant the main support of modularization branch support in the inside of main part tectorial membrane support, make its branch tectorial membrane support stretch out the window and stretch into to the branch blood vessel that corresponds in, because the near-end and/or the distal end that is located the position on the main support of the root tectorial membrane of the branch tectorial membrane support of implanting are provided with adjacent blood vessel and dodge the groove, thereby, after implanting branch tectorial membrane support, branch tectorial membrane support can not cause the shutoff to adjacent branch blood vessel, simultaneously because the main support supports inside main part tectorial membrane support, thereby can fully prevent to take place the internal leakage.

The embodiment of the invention has simple structure and convenient implantation, reconstructs the blood supply of the aorta and the branch arteries thereof in the shortest possible time, and relieves the technical problem that the prior covered stent is not beneficial to the application of a minimally invasive endovascular intervention isolation operation on the aortic arch in the prior art.

Drawings

In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below, and it is obvious that the drawings in the following description are some embodiments of the present invention, and other drawings can be obtained by those skilled in the art without creative efforts.

FIG. 1 is a top view of an alternative embodiment of a main body stent graft of a modular aortic arch stent graft according to an embodiment of the present invention;

FIG. 2 is an elevational view of the overall construction of the main body stent graft of FIG. 1;

FIG. 3 is a top view of an alternative embodiment of a main body stent graft of the modular aortic arch stent graft according to an embodiment of the present invention;

FIG. 4 is an elevational view of the overall structure of a first modular stent of the modular aortic arch stent graft provided in accordance with an embodiment of the present invention;

FIG. 5 is an overall structural elevation view of a middle modular stent of the modular aortic arch stent graft provided in accordance with an embodiment of the present invention;

FIG. 6 is an overall structural elevation view of a second modular stent of the modular aortic arch stent graft provided in accordance with an embodiment of the present invention;

FIG. 7 is a schematic view of an alternative implantation of the modular aortic arch stent graft provided by an embodiment of the present invention;

FIG. 8 is a schematic view of an alternative implantation of a modular aortic arch stent graft according to embodiments of the present invention.

Icon: 1-main body covered stent; 100-window; 110-development marker points; 11-a backbone; 111-left annular support armature; 112-longitudinal beams; 113-right annular support armature; 12-coating a film; 2-modular branch support; 201-a first module support; 202-middle module support; 203-a second module support; 204-branch scaffold; 21-a main support; 22-branch stent graft; 200-adjacent vessel avoidance slots.

Detailed Description

In order to make the objects, technical solutions and advantages of the embodiments of the present invention clearer, the technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are some, but not all, embodiments of the present invention. The components of embodiments of the present invention generally described and illustrated in the figures herein may be arranged and designed in a wide variety of different configurations.

Thus, the following detailed description of the embodiments of the present invention, presented in the figures, is not intended to limit the scope of the invention, as claimed, but is merely representative of selected embodiments of the invention. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.

It should be noted that: like reference numbers and letters refer to like items in the following figures, and thus, once an item is defined in one figure, it need not be further defined and explained in subsequent figures.

In the description of the present invention, it should be noted that the terms "upper", "lower", "vertical", "horizontal", "inner", "outer", and the like indicate orientations or positional relationships based on orientations or positional relationships shown in the drawings or orientations or positional relationships conventionally laid out when products of the present invention are used, and are only for convenience of description and simplicity of description, and do not indicate or imply that the referred devices or elements must have a specific orientation, be constructed in a specific orientation, and be operated, and thus, should not be construed as limiting the present invention. Furthermore, the terms "first," "second," "third," and the like are used solely to distinguish one from another and are not to be construed as indicating or implying relative importance.

Furthermore, the terms "horizontal", "vertical" and the like do not imply that the components are required to be absolutely horizontal or pendant, but rather may be slightly inclined. For example, "horizontal" merely means that the direction is more horizontal than "vertical" and does not mean that the structure must be perfectly horizontal, but may be slightly inclined.

In the description of the present invention, it should also be noted that, unless otherwise explicitly specified or limited, the terms "disposed," "mounted," and "connected" are to be construed broadly, e.g., as meaning fixedly connected, detachably connected, or integrally connected; can be mechanically or electrically connected; they may be connected directly or indirectly through intervening media, or they may be interconnected between two elements. The specific meanings of the above terms in the present invention can be understood in specific cases to those skilled in the art.

Some embodiments of the invention are described in detail below with reference to the accompanying drawings. The embodiments described below and the features of the embodiments can be combined with each other without conflict.

The present embodiment provides a modular aortic arch stent graft, which, referring to fig. 1 to 8, includes a main body stent graft 1 and modular branch stents 2.

Specifically, the main body stent graft 1 comprises a framework 11 and a graft 12; a window 100 is arranged on the covering film 12 corresponding to the three branches of the aortic arch part blood vessel of the patient, and the edge of the window 100 is provided with a developing marker; the modularized branch stent 2 comprises a main stent 21 and a branch covered stent 22 connected to the side part of the main stent 21, wherein the main stent 21 and the branch covered stent 22 are both formed into a cylinder shape, a root covered stent is arranged at the part of the main stent 21 connected with the branch covered stent 22, adjacent blood vessel avoiding grooves 200 are arranged at the near end and/or the far end of the part of the root covered stent positioned on the main stent 21, and developing markers are arranged at the edges of the adjacent blood vessel avoiding grooves 200; the modular branch stent 2 is configured to be attachable to the main stent graft 1 such that the main stent graft 21 is nested within the stent graft 12 of the main stent graft 1 and the branch stent graft 22 extends out of the window 100.

When the stent graft is implanted, under the coordination of a developing marker and X-rays, the main body stent graft 1 is implanted into an aorta by utilizing an implanting device, the window 100 is made to correspond to the three branch positions of the aortic arch part blood vessel of a patient, then the main bracket 21 of the modularized branch stent graft 2 is implanted into the main body stent graft 1, the branch stent graft 22 extends out of the window 100 and extends into the corresponding branch blood vessel, and because the near end and/or the far end of the part, which is positioned on the main bracket 21, of the root part of the implanted branch stent graft 22 is provided with the adjacent blood vessel avoiding groove 200, after the branch stent graft 22 is implanted, the branch stent graft 22 does not block the adjacent branch blood vessel, and meanwhile, because the main bracket 21 is supported inside the main body stent graft 1, the internal leakage can be fully prevented.

The stent graft has the advantages of simple structure and convenient implantation, can reconstruct the blood supply of the aorta and the branch arteries thereof in the shortest possible time, and solves the technical problem that the prior stent graft is not beneficial to the application of a minimally invasive endovascular intervention isolation operation to the aortic arch in the prior art. In the present embodiment, the specific shape of the window 100 may be, but is not limited to, an ellipse, a rounded rectangle, an arc, etc., and is not limited thereto.

Referring to fig. 1 and 2, in an alternative embodiment of the present embodiment, it is preferable that the frame 11 includes a left annular supporting frame 111, a right annular supporting frame 113, and a plurality of longitudinal beams 112 connecting the left annular supporting frame 111 and the right annular supporting frame 113, and the coating film 12 covers an outer circumferential surface of the frame 11 and extends from the left annular supporting frame 111 to the right annular supporting frame 113. The skeleton 11 is bent into an arch shape adapted to the aortic arch of the patient, and the window 100 is opened at a portion of the cover film 12 corresponding to the plurality of longitudinal beams 112. The longitudinal beams can be parallel to each other or cross with each other, and the annular supporting framework is not arranged at the windowing part, so that the integral bending prefabrication of the framework 11 is facilitated, the framework 11 of the main body covered stent 1 is bent into an arch shape adapted to the aortic arch of a patient as much as possible, and the degree of adaptation to the human body is improved; meanwhile, only the longitudinal beam is arranged and the annular support is not arranged, so that the shortening of the main body covered stent 1 can be effectively prevented, the straightening force of the main body covered stent 1 is fully reduced, the damage to the blood vessel wall is reduced, and the damage to the blood vessel wall caused by the implantation of the stent is reduced or prevented.

The longitudinal direction of the longitudinal beam in the present embodiment refers to the axial direction of the body stent graft 1.

Referring to fig. 4-8, in an alternative embodiment of this embodiment, module branching support 2 preferably includes a first module support 201, a second module support 203, and a middle module support 202; adjacent blood vessel avoidance grooves 200 are formed in the distal end of the root covering film of the first modular stent 201, the proximal end of the root covering film of the second modular stent 203, the proximal end of the root covering film of the middle modular stent 202 and the distal end of the root covering film of the middle modular stent 202. The distal end of the root tectorial membrane of the first modular support 201 is slotted to prevent the obstruction of blood supply of the left common carotid artery, the proximal end of the middle modular support 202 is slotted to prevent the obstruction of blood supply of the innominate artery, and the distal end of the middle modular support 202 is slotted to prevent the obstruction of blood supply of the left subclavian artery; the proximal end of the root tectorial membrane of the second modular support 203 is slotted to prevent the obstruction of blood supply of the left common neck branch blood vessel, and the collocation can be selected according to the conditions of interlayer breach and the like during the specific operation, if the interlayer only affects the left subclavian artery, the second modular support 203 can be selected independently, if the interlayer affects the three branches, the three modular supports are required to be implanted respectively, the implantation sequence is not sequential, and the operation is flexible and convenient.

Referring to figure 3 in conjunction with figures 4 to 8, in some alternative embodiments of this embodiment, module branch support 2 comprises a first module support 201 and a middle module support 202; the distal end of the root covering film of the first modular stent 201, the proximal end of the root covering film of the middle modular stent 202 and the distal end of the middle modular stent 202 are all provided with adjacent blood vessel avoiding grooves 200; a branch stent 204 is connected to the part of the main covered stent 1 close to the window 100; namely, the main stent graft 1 is provided with a branch stent graft, the window 100 corresponds to the innominate artery and the left common carotid artery, and the first modular stent graft 201 and the middle modular stent graft 202 are selected to be implanted alternatively or simultaneously.

In some alternative embodiments of this embodiment, adjacent vessel-avoiding grooves 200 are C-shaped or U-shaped.

In some optional embodiments of the present embodiment, the main stent 21 is a covered stent, and the root covering membrane and the covering membrane of the main stent are the same covering membrane; or the main stent 21 is a bare stent, the root tectorial membrane is a tectorial membrane patch, and the tectorial membrane patch is connected with the branch tectorial membrane stent 22 in a tectorial membrane integrated manner or in a sewing manner.

In some optional embodiments of the present embodiment, in the modular branch stent 2, the included angle between the axial direction of the main stent 21 and the axial direction of the branch stent graft 22 is 70 degrees or 110 degrees or any angle between 70 degrees and 110 degrees.

In some alternative embodiments of the present embodiment, gold yellow wire is used as the visualization marker adjacent to the edge of the blood vessel avoidance slot 200.

In some optional embodiments of the present embodiment, the developing marker is provided at the edge of the window 100 in a plurality, and the plurality of developing markers are arranged along the edge of the window 100 at intervals in pairs to form a plurality of developing marker points 110, so as to enhance the developing effect.

Finally, it should be noted that: the embodiments in the present description are all described in a progressive manner, each embodiment focuses on the differences from the other embodiments, and the same and similar parts among the embodiments can be referred to each other; the above embodiments in the present specification are only used for illustrating the technical solutions of the present invention, and not for limiting the same; while the invention has been described in detail and with reference to the foregoing embodiments, it will be understood by those skilled in the art that: the technical solutions described in the foregoing embodiments may still be modified, or some or all of the technical features may be equivalently replaced; and the modifications or the substitutions do not make the essence of the corresponding technical solutions depart from the scope of the technical solutions of the embodiments of the present invention.

Claims (10)

1. The modular aortic arch part covered stent is characterized by comprising a main body covered stent (1) and modular branch stents (2);

the main body covered stent (1) comprises a framework (11) and a covering membrane (12); a window (100) is arranged on the covering film (12) corresponding to the position of three branches of the aortic arch part blood vessel of the patient, and a developing marker is arranged on the edge of the window (100);

the modularized branch stent (2) comprises a main stent (21) and a branch tectorial membrane stent (22) connected to the side part of the main stent (21), wherein the main stent (21) and the branch tectorial membrane stent (22) are both formed into a cylinder shape, a root tectorial membrane is arranged at the part of the main stent (21) connected with the branch tectorial membrane stent (22), an adjacent blood vessel avoiding groove (200) is arranged at the near end and/or the far end of the part of the root tectorial membrane positioned on the main stent (21), and a developing marker is arranged at the edge of the adjacent blood vessel avoiding groove (200);

the modular branch stent (2) is configured to be connected to the main body covered stent (1) in a manner that the main stent (21) is sleeved inside the covering membrane (12) of the main body covered stent (1) and the branch covered stent (22) extends out of the window (100).

2. The modular aortic arch stent of claim 1,

the framework (11) comprises a left annular supporting framework (111), a right annular supporting framework (113) and a plurality of longitudinal beams (112) which are connected with the left annular supporting framework (111) and the right annular supporting framework (113), and the coating (12) covers and is connected to the outer circumferential surface of the framework (11) and extends from the left annular supporting framework (111) to the right annular supporting framework (113);

the framework (11) is integrally bent into an arch shape adaptive to the aortic arch of a patient, and the window (100) is arranged on the position, corresponding to the longitudinal beams (112), on the covering film (12).

3. The modular aortic arch stent graft of claim 1, wherein the modular branch stent (2) comprises a first modular stent (201), a second modular stent (203), and a middle modular stent (202);

the distal end of the root tectorial membrane of first modular bracket (201), the proximal end of the root tectorial membrane of second modular bracket (203), the proximal end of the root tectorial membrane of middle part modular bracket (202) and the distal end of the root tectorial membrane of middle part modular bracket (202) has all been seted up adjacent blood vessel dodges groove (200).

4. The modular aortic arch stent graft of claim 1, wherein the modular branch stent (2) comprises a first modular stent (201) and a middle modular stent (202);

the far end of the root coating of the first modular bracket (201), the near end of the root coating of the middle modular bracket (202) and the far end of the root coating of the middle modular bracket (202) are all provided with the adjacent blood vessel avoidance grooves (200); a branch stent (204) is connected to the part, close to the window (100), of the main body covered stent (1).

5. The modular aortic arch stent of claim 1, wherein the adjacent vessel evading groove (200) is C-shaped or U-shaped.

6. The modular aortic arch stent of claim 1, wherein the main stent (21) is a stent graft, the root graft being the same graft as the main stent graft; or the main stent (21) is a bare stent, and the root tectorial membrane is a tectorial membrane patch.

7. The modular aortic arch stent of claim 6, wherein the graft patch is connected to the graft of the branch stent graft (22).

8. The modular aortic arch stent graft of claim 1, wherein the angle between the axial direction of the main stent (21) and the axial direction of the branch stent graft (22) in the modular branch stent (2) is 70-110 degrees.

9. The modular aortic arch stent graft of claim 1, wherein the visualization marker of the edge of the adjacent vessel evasion slot (200) is gold wire.

10. The modular aortic arch stent graft of claim 1, wherein the visualization marker at the edge of the window (100) is in a plurality, and the plurality of visualization markers are spaced two by two along the edge of the window (100) to form a plurality of visualization marker points (110).

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