Improved Remodeling With TEVAR and Distal Bare-Metal Stent in Acute Complicated Type B Dissection
Articolo
Data di Pubblicazione:
2020
Citazione:
Improved Remodeling With TEVAR and Distal Bare-Metal Stent in Acute Complicated Type B Dissection / C.A. Nienaber, X. Yuan, M. Aboukoura, P. Blanke, R. Jakob, R.A. Janosi, L. Lovato, V. Riambau, J. Trebacz, S. Trimarchi, B. Zipfel, J.C. van den Berg. - In: ANNALS OF THORACIC SURGERY. - ISSN 0003-4975. - 110:5(2020), pp. 1572-1579. [10.1016/j.athoracsur.2020.02.029]
Abstract:
Background: The ASSIST (A multicentre Study in Survivors of type B aortic dissection undergoing Stenting) study compared both 1-year outcomes and evolution of true and false lumen (eg, remodeling) in patients with complicated type B aortic dissection subjected to thoracic endovascular aortic repair (TEVAR) with distal true lumen scaffolding by self-expanding nitinol open stent in comparison with TEVAR alone. Methods: The ASSIST study was a multicenter prospective single-arm study comparing clinical and imaging data from 39 consecutive patients (59.4 ± 13 years of age) who received TEVAR and the JOTEC E-XL open stent with data from matched control subjects treated with TEVAR alone based on 1:1 propensity score matching. Clinical data were collected by an independent Contract Research Organization (CRO) and computed tomography images were subjected to blinded core-lab analysis. Results: There were no differences in baseline demographics, clinical profiles, morphological data, procedural details, and in-hospital and 1-year outcomes between groups. Differences emerged with regard to evolution of both true lumen distal to stent graft, false lumen over the entire length of dissection, and remodeling (P <.001). At 1 year, TEVAR with the E-XL stent revealed false lumen thrombosis at the level of celiac trunk in 53.8% vs 17.9% with TEVAR alone (P =.004). Kaplan-Meier survival analysis indicated favorable clinical outcomes with the additional E-XL stent. Conclusions: TEVAR for acute complicated type B aortic dissection proved to be safe and promoted remodeling of the stent grafted thoracic aorta. Additional scaffolding of the true lumen distal to TEVAR with a self-expanding stent supported distal true lumen expansion, false lumen regression, and thrombosis, with evidence of improved distal remodeling at 1 year.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Adult; Aged; Aneurysm, Dissecting; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Middle Aged; Prospective Studies; Vascular Remodeling; Stents
Elenco autori:
C.A. Nienaber, X. Yuan, M. Aboukoura, P. Blanke, R. Jakob, R.A. Janosi, L. Lovato, V. Riambau, J. Trebacz, S. Trimarchi, B. Zipfel, J.C. van den Berg
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