Endovascular repair of type B aortic dissection with the restrictive bare stent technique: morphologic changes, technique details, and outcomes.

Published on Oct 12, 2018in Therapeutics and Clinical Risk Management2.423
· DOI :10.2147/TCRM.S177757
Binshan Zha3
Estimated H-index: 3
(Anhui Medical University),
Geliang Xu1
Estimated H-index: 1
(Anhui Medical University)
+ 4 AuthorsPeng Qiu3
Estimated H-index: 3
(Anhui Medical University)
Sources
Abstract
Purpose: The aim of this study was to present our experience and assess the morphologic changes of the descending aorta after the restrictive bare stent (RBS) technique in the treatment of type B aortic dissection (TBAD). Patients and methods: A retrospective study was conducted of 22 consecutive patients with TBAD who underwent RBS treatment between February 2012 and June 2016. Indications for the RBS procedure included radiological evidence of true lumen (TL) compression or collapse and/or tortuosity index (TI) of the descending aorta >1.4. Technique success, descending aorta morphology, and clinical outcomes were evaluated. Results: The technical success rate was 100%. Patients treated with the RBS technique were often accompanied by TL collapse (45.5%) or TI >1.4 (59.1%). One-month postoperative computed tomography angiography showed that the taper ratio, oversizing ratio of the stent graft, and TI values were significantly decreased compared with preoperative computed tomography angiography values (P<0.05). The 30-day mortality rate was 0%. In total 95.2% had a thrombosed false lumen in the segment of aortic coverage, and TL diameters were increased in 40.3%±11% (mean ± SD) and 37.5%±17.9% of patients in the thoracic and abdominal segments, respectively. During the follow-up from 16 to 64 months (33±19 months), no distal stent graft-induced new entry, endoleak, and paraplegia were observed. One patient died from rupture of a chronic TBAD with aneurysm degeneration. Conclusion: Mid-term outcomes showed RBS to be a flexible and feasible approach to repair TBAD. RBS corrects the descending aorta morphology and promotes TL expansion in most patients, but the rupture of chronic TBAD with aneurysm degeneration was not prevented in all patients.
References29
Newest
Background: Stanford type B aortic dissection is one of the aortic catastrophes with a high mortality and morbidity that needs immediate or delayed treatment, either surgically or endovascularly. This comprehensive review article addresses the current status of open, endovascular and hybrid treatment options for type B aortic dissections with the focus on new therapeutic perspectives. Methods: Evaluation of currently available evidence based on randomized and registry data and personal experienc...
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#1Yang Zhao (SYSU: Sun Yat-sen University)H-Index: 5
#2Henghui Yin (SYSU: Sun Yat-sen University)H-Index: 10
Last. Guangqi Chang (SYSU: Sun Yat-sen University)H-Index: 14
view all 7 authors...
Abstract Objective Distal stent graft-induced new entry (SINE) can occur after thoracic endovascular aortic repair (TEVAR) of type B aortic dissection. This study investigated the mechanism of distal SINE and its prevention using a restrictive bare stent (RBS) technique. Methods From January 2013 to December 2014, 68 consecutive type B aortic dissection patients received endovascular repair at our center. The RBS technique was used with distal oversizing (between the diameter of the thoracic ste...
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#1Hyunsik Jang (Yonsei University)H-Index: 2
#2Man Deuk Kim (Yonsei University)H-Index: 19
Last. Do Yun Lee (Yonsei University)H-Index: 28
view all 8 authors...
Abstract Objective Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. SINE is often life threatening, and reintervention is required. This study investigated risk factors for SINE after TEVAR. Methods From July 2001 to June 2013, we retrospectively analyzed data from 79 patients who underwent TEVAR for Stanford type B aortic dissection. TEVAR was performed in 17 patients ≤2 weeks (acute) aft...
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#1Sven PeterssH-Index: 19
#2Ahmed M. Mansour (Yale University)H-Index: 5
Last. John A. Elefteriades (Yale University)H-Index: 77
view all 11 authors...
We review current knowledge regarding the natural transition of aortic dissection from acute to chronic stages. As this is not well understood, we also bring to bear new data from our institution. Type A dissection rarely transitions naturally into the chronic state;consequently, information is limited. Type B dissections are routinely treated medically and indeed undergo substantial changes during their temporal course. General patterns include: 1) the aorta dilates and, absent surgical interve...
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#1Antonio Pantaleo (UNIBO: University of Bologna)H-Index: 16
#2Giuliano Jafrancesco (UNIBO: University of Bologna)H-Index: 6
Last. Davide Pacini (UNIBO: University of Bologna)H-Index: 48
view all 9 authors...
Background Aortic dissection is a major cardiovascular disease associated with a high mortality rate. In complicated type B dissection, with favorable anatomy, endovascular surgical repair (thoracic endovascular aortic repair [TEVAR]) is considered the treatment of choice. Intimomedial injury induced by stent graft, or stent graft-induced new entry (SINE), has a clinically significant incidence. SINE can occur at the proximal or distal level of the stent graft. The aim of this retrospective stud...
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#1I-Ming Chen (NYMU: National Yang-Ming University)H-Index: 9
#2Chun-Yang Huang (NYMU: National Yang-Ming University)H-Index: 7
Last. Chun-Che Shih (NYMU: National Yang-Ming University)H-Index: 10
view all 7 authors...
Objective This study investigated predisposing factors of distal stent graft-induced new entry (SINE). Methods Data from November 2006 to May 2012 were abstracted retrospectively from the records of 73 patients with complicated type B aortic dissection who had received stent graft treatment in our institution. Diameters of the true and false lumen, area and circumference of the true lumen, prestent and poststent oversize, taper, and mismatch ratio were recorded and analyzed to see if there were ...
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Abstract. Background: The objective was to explore the outcomes and aortic remodelling after proximal thoracic endovascular aortic repair (TEVAR) in post type B aortic dissection thoracic aneurysm with a maximal diameter ≥ 5.5cm. Patients and methods: 34 cases of type B aortic dissection thoracic aneurysm undergoing proximal TEVAR (coverage of the primary entry and the aneurysm extent) from 2008 to 2013 were retrospectively reviewed with follow-up for at least 2 years. The primary endpoints were...
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#1Fabrizio Fanelli (Sapienza University of Rome)H-Index: 31
#2Alessandro Cannavale (Sapienza University of Rome)H-Index: 9
Last. Carlo Catalano (Sapienza University of Rome)H-Index: 71
view all 8 authors...
Abstract Objectives The aim of this study was to assess factors influencing the clinical outcome and morphological changes of acute and chronic type B aortic dissection after thoracic endovascular aortic repair (TEVAR). Background Aortic remodeling after TEVAR may be associated with clinical outcome, complications, and endoleak development. Methods Sixty cases of TEVAR for complicated type B acute aortic dissection (AAD) (n = 29) and chronic aortic dissection (CAD) (n = 31) with a minimum follow...
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#1Qing Li (Capital Medical University)H-Index: 4
#2Long-Fei Wang (Capital Medical University)H-Index: 5
Last. Li-Zhong Sun (Capital Medical University)H-Index: 25
view all 8 authors...
Background: Distal stent graft-induced new entry (DSINE) has been increasingly observed following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We seek to identify the risk factors for DSINE following TEVAR in patients with TBAD. Methods: Between January 2009 and January 2013, we performed TEVAR for 579 patients with TBAD. The clinical data were retrospectively analyzed with univariate and multivariate analyses to identify the risk factors for DSINE. Results: T...
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#1Hao He (Yale University)H-Index: 7
#2K. Yao (CSU: Central South University)H-Index: 1
Last. Alan Dardik (Yale University)H-Index: 55
view all 7 authors...
Objective This study evaluates the safety and efficacy of pre-placement of a distal bare stent as an adjunct to thoracic endovascular aortic repair (TEVAR) in the setting of complicated acute Stanford type B aortic dissection (cTBAD). Methods The records of all patients diagnosed with cTBAD at the institution between 2010 and 2013 were reviewed. Indications for the pre-placement of a distal bare stent included symptomatic malperfusion and/or radiological evidence of true lumen collapse. Computed...
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Cited By3
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#1Peng Qiu (SJTU: Shanghai Jiao Tong University)H-Index: 3
#2Binshan Zha (Anhui Medical University)H-Index: 3
Last. Xinwu Lu (SJTU: Shanghai Jiao Tong University)H-Index: 22
view all 9 authors...
Abstract Background The efficacy and safety of combined proximal covered stent-grafting with distal bare stenting are controversial because of the lack of evidence. This systematic review and meta-analysis compares the outcomes of combined proximal covered stent-grafting with those of distal bare stenting (BS group) and proximal covered stent-grafting without distal bare stenting (non-BS group). Methods The MEDLINE, EMBASE, and Cochrane Central Register for Controlled Trials databases and key re...
Source
#1Binshan Zha (Anhui Medical University)H-Index: 3
#2Peng Qiu (SJTU: Shanghai Jiao Tong University)H-Index: 3
Last. Huagang Zhu (Anhui Medical University)H-Index: 3
view all 7 authors...
Background This study aims to investigate the descending aortic morphological alterations caused by pathological changes in acute and chronic Type B aortic dissection (TBAD) and morphological remodeling after thoracic endovascular aortic repair (TEVAR).
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