A Novel Method Improving Estimation of Distal Landing Zone and Remodeling in Endovascular Repair of Type B Aortic Dissection

Abstract

Objectives:

Tapered stent graft has been used to reduce distal stent graft-induced new entry (SINE), but there is no solid evidence for distal size selection about grafting in the dissected distal landing zone. We aimed to estimate the distal stent size based on the estimated normal aorta before dissection onset and remodeling after thoracic endovascular aortic repair (TEVAR) in the study.

Methods:

Patients received TEVAR from July 2016 to June 2024 were regrouped into 3 groups based on differentials between estimated distal stent size and actual distal stent size (group A: differentials within 0-1 mm; group B: actual distal stent size smaller than estimated distal stent size, differentials >1 mm; group C: actual distal stent size larger than estimated distal stent size, differentials >1 mm). Remodeling condition was divided into full remodeling (complete false lumen reduction), complete false lumen thrombosis, and non-remodeling. Clinical and morphological data were collected and analyzed. Risk factors of full remodeling and survival data were determined and evaluated.

Results:

Ninety patients were included in this study. Full remodeling was significantly satisfied in group A (78.1%) than in group B (21.4%) and group C (46.7%, p<0.05). Distal SINE was significantly higher in group C (13.3%) than group A (0%) and group B (0%, p<0.05). The cumulative 5-year full remodeling rate was significantly higher in group A than in group B and group C (p<0.05). Multivariate Cox regression analysis revealed that differentials between estimated distal stent size and actual distal stent size were a significant predictive factor of full remodeling after TEVAR (p<0.05).

Conclusion:

Distal stent size selected by estimated normal aorta size could promote full remodeling at the dissected aorta after TEVAR, with low risk of distal SINE.

Clinical Impact

Distal stent size selected by estimated normal aorta size could promote aortic remodeling and false lumen complete reduction (full remodeling) at stented section after endovascular therapy in type B dissection patient.

Keywords

type B aortic dissection normal aorta size distal landing zone distal stent size thoracic endovascular aortic repair

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