Early results of a low-profile stent-graft for thoracic endovascular aortic repair

Abstract

Purpose To assess outcomes of a low-profile thoracic stent-graft in the treatment of thoracic aortic pathologies. Methods A retrospective analysis of all consecutive patients with aortic thoracic pathologies treated with the RelayPro device in two university hospitals between October 2018 and July 2019. Results 23 patients (65% men; mean age 63.4 ± 15 years) were treated. Pathologies included aortic dissections (n = 10), 5 residual type A (22%) and 5 type B (22%), 6 degenerative aortic aneurysms (26%), 4 penetrating aortic ulcers (17%), and aortic erosion, intramural hematoma and aortic rupture (n = 1 and 4% in each case). Two cases (9%) were emergent and two urgent. Proximal landing was achieved in zones 0 (4%), 1 (4%), 2 (43%), and 3 (26%). Five grafts were frozen elephant trunk extensions. Technical success was 100% with accurate device deployment in the intended landing zone of the aortic arch in all 23 patients and with no Ia/III endoleaks and three (13%) type II endoleaks. Apposition was adequate in 96%. Two patients had post-implantation syndromes (one fever, one leukocytosis). Mean follow-up was 11.6 ± 3.7 months (range, 2–16) with no other complications, secondary interventions or conversions to open surgery. There was no 30-day mortality and no aortic-related mortality; all-cause mortality was 4% during follow-up. Conclusion A 3–4 French reduced profile in the current generation of stent-grafts facilitates TEVAR particularly in patients with smaller vessels access. Early safety and effectiveness outcomes are favorable, even in endpoints such as deployment accuracy and apposition which may be surrogates for longer-term clinical success and durability.

A systematic review and meta-analysis of retrograde type A aortic dissection after thoracic endovascular aortic repair in patients with type B aortic dissection

“…Four studies described RTAD as asymptomatic after TEVAR. Detailed description of the clinical presentation of RTAD is provided in Chassin-Trubert [76] [77] 2019 (2015-2018) France Paris SC 22 20 0 NR NR NR NR Jiechang Zhu [78] 2018 (2015-2016) China Tianjin SC 6.95 20 0 53 NR 16 NR Riesterer [79] 2018 (2002-2017) Germany Freiburg SC 16 34 1 NR NR NR NR Giles [12] 2019 (2005-2016) USA Gainesville SC 17 258 12 61.5 NR 203 NR Kuo [80] 2019 (2006-2016) USA Los Angeles SC 14 71 2 58.6 NR 52 NR Joo [81] 2019 South Korea Seoul SC NR 17 2 50.4 42 14 2 Cao [82] 2020 [83] 2020 (2018-2019) Germany Mainz, Tübingen NMC 11.6 5 0 NR NR NR NR Charltonouw [84] 2018 (1999-2014) USA Houston SC 51.6 43 3 NR NR NR NR Lou [85] 2020 (2012-2018) USA South Carolina SC 36 91 3 52.6 NR 60 NR Lee [86] 2020 Oshi [87] 2020 (2009-2019) Japan Fukuoka SC 39.2 40 1 66.5 NR 26 NR Puech-Leao [88] 2020 [89] 2020 [90] 2020 (2009-2018) China Shandong SC 10.7 79 1 49.9 NR 61 NR Bavaria [91] 2015 [92] 2018 (2007-2015) France Marseille SC 29 26 2 NR NR NR NR Ding [93] 2018 [95] 2016 [10] 2019 (2013-2017) China Zhejiang SC 25.8 571 12 NR NR NR NR Gao [8] 2019 diagnosed by CT at regular and irregular imaging follow-up period, respectively. According to Kruskal Wallis Test, cumulative incidence of RTAD did not statistically differ among the studies with regular or irregular imaging follow-up period (P = .63).…”

“…The literature search yielded 1963 potentially eligible articles. After considering our selection criteria, 78 eligible clinical studies [4,5,8,10,12,14,17,25–95] published between 2002 and 2020 were enrolled in the qualitative and quantitative analysis (Fig. 1).…”

Lower-profile stent graft reduces the risk of embolism during thoracic endovascular aortic repair in shaggy aorta

“…Among recent advancements in stent graft technology, LPSG might contribute to reducing embolization by less friction to the aortic wall during TEVAR compared with the CSSG. El Beyrouti et al [ 16 ] reported the early results of TEVAR using RELAY pro devices, of which the delivery sheath is designed 3- to 4-Fr smaller in outer diameter than the previous-generation devices of RELAY Plus. Their study revealed no thromboembolic complications, including endograft thrombosis, obstruction, stroke and SCI.…”

One-year results with a low-profile endograft in subjects with thoracic aortic aneurysm and ulcer pathologies

“…10 In another repo1i of 13 PAU patients with persisting or recmTent, dissection-type, interscapular pain were treated with RelayPro with only one late type II endoleak that did not require additional treatment; there was no stroke or paraplegia, and no bleeding complication (including three patients undergoing prior percutaneous coronaiy intervention and receiving dual oral antiplatelet regimen).11 In a dual-center repo1i from Ge1many of 23 patients treated with RelayPro, pathologies included 5 residual type A dissection (22%) and 5 type B (22%), 6 degenerative ao1iic anemysms (26%), 4 penetrating ao1iic ulcers (17%), and ao1iic erosion, intramural hematoma and ao1iic rnpture (4% in each case). 12 Two cases (9%) were emergent and two urgent; proximal landing was in zones 0 (4%), 1 (4%), 2 (43%), and 3 (26%); five grafts were frozen elephant tiunk extensions.…”