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

Abstract

OBJECTIVES This study aimed to reveal the association between lower-profile stent graft and embolism during thoracic endovascular aortic repair for non-dissecting distal arch and descending thoracic aortic aneurysm. METHODS This study reviewed data of 35 patients who underwent thoracic endovascular aortic repair with lower-profile stent graft (27 males; age: 77 ± 9.2 years) and 312 who underwent thoracic endovascular aortic repair with conventional-sized stent graft (247 males; age: 77 ± 7.4 years) from 2009 to 2021. RESULTS The rate of total embolic events was significantly lower in lower-profile stent graft group (0/35 [0%]) than the conventional-sized stent graft group (34/312 [11.2%]) (p = 0.035). Shaggy aorta (odds ratio: 5.220; p < 0.001) were identified as positive embolic event predictors. The rate of total embolic events in 68 patients with shaggy aorta (12 in lower-profile stent graft/56 in conventional-sized stent graft) was significantly lower in the lower-profile stent graft group (0/12 [0%]) than the conventional-sized stent graft group (19/56 [34%]) (p = 0.015). The rate of total embolic events in 279 patients with the non-shaggy aorta (23 in lower-profile stent graft/256 in conventional-sized stent graft) reveals no difference between the two groups (0 [0%]/16 [6.3%]) (p = 0.377). CONCLUSIONS Lower-profile stent graft usage could reduce embolism in thoracic endovascular aortic repair, and the difference was more pronounced in patients with the shaggy aorta. Lower-profile stent graft might be beneficial in preventing embolism in thoracic endovascular aortic repair for patients with a shaggy aorta.