New technical approach for type B dissection: from the PETTICOAT to the STABILISE concept

Kahlberg, Andrea; Mascia, Daniele; Bertoglio, Luca; Loschi, Diletta; Grandi, Alessandro; Melissano, Germano; Chiesa, Roberto

doi:10.23736/s0021-9509.19.10904-4

Cited by 17 publications

(47 citation statements)

References 18 publications

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“…The body of literature considering the STABILISE concept to treat acute and subacute complicated TBAD is growing. 42 – 44 Likewise, the MFM might be used within the STABILISE concept to induce laminar flow and aortic remodeling while preserving branch patency, even without proximal endografts.…”

Section: Discussionmentioning

confidence: 99%

“…The body of literature considering the STABILISE concept to treat acute and subacute complicated TBAD is growing. [42][43][44] Likewise, the MFM might be used within the STABILISE concept to induce laminar flow and aortic remodeling while preserving branch patency, even without proximal endografts. Furthermore, early thoracic endografting may be considered selectively in uncomplicated acute TBAD, and promising initial results were presented in the ADSORB trial.…”

Section: Discussionmentioning

confidence: 99%

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One-Year Single-Center Results of the Multilayer Flow Modulator Stents for the Treatment of Type B Aortic Dissection

et al. 2020

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Purpose To report a single-center series of patients with type B aortic dissection treated with the Multilayer Flow Modulator (MFM). Materials and Methods Over a 36-month period, 23 patients (median age 53 years; 20 men) with complicated type B aortic dissections (2 acute, 5 subacute, and 16 chronic) were treated with the MFM. Primary endpoints of rupture or dissection-related death, overall mortality, and reintervention were evaluated using the Kaplan-Meier method; estimates for freedom from the endpoints are reported with the 95% confidence interval (CI). Secondary outcomes included technical success, adverse events, and aortic remodeling. Clinical and imaging data were collected preoperatively, directly postoperatively, and annually to 36 months for analysis using computational fluid dynamics (CFD). Results Initial technical success was 91.3%. The estimates of the endpoints at 12 months were 100% for freedom from rupture or aortic-related death, 95.7% for freedom from overall mortality, and 91.3% for freedom from reintervention. No device-related neurological or systemic complications occurred, and no additional reinterventions were needed during follow-up. A total of 144 branches overstented by the MFM remained patent. Morphologic analysis of the aortic dissection showed progressive true lumen volume increase (75.9%, p<0.001) with concomitant false lumen volume decrease (42.8%, p<0.001); the CFD analyses showed increased laminar flow. Conclusion In the current series, the MFM provided a safe and feasible treatment option for complicated acute, subacute, and chronic type B aortic dissections, with high technical success, low mortality, and active aortic remodeling. Further studies should elucidate the long-term safety of the MFM and its effectiveness in a larger patient cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

One-Year Single-Center Results of the Multilayer Flow Modulator Stents for the Treatment of Type B Aortic Dissection

et al. 2020

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“…All aortic ruptures were reported in the PETTICOAT subgroup, leading to an early aortarelated death rate of 1.4% (3/216) [10,[17][18][19]27]. SINE was recorded in four studies, two of them reporting on the STABILISE technique [17,23,25,27]. Two events were reported, both patients were managed with the PETTICOAT technique [total cohort rate: 2.3% (2/84), PETTICOAT rate: 3.8% (2/57)] [17,27].…”

Section: Early Outcomesmentioning

confidence: 99%

A Systematic Review on PETTICOAT and STABILISE Techniques for the Management of Complicated Acute Type B Aortic Dissection

Nana¹,

Kouvelos²,

Behrendt³

et al. 2023

Rev. Cardiovasc. Med.

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Background: Extended downstream endovascular management has been applied in acute complicated type B aortic dissection (acT-BAD), distally to standard thoracic endovascular aortic repair (TEVAR), using bare metal stents, with or without lamina disruption, using balloon inflation. The aim of this systematic review was to assess technical success, 30-day mortality, and mortality during followup in patients with acTBAD managed with the Provisional Extension To Induce Complete Attachment (PETTICOAT) or stent-assisted balloon-induced intimal disruption and relamination (STABILISE) technique. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement was followed. A search of the English literature, via Ovid, using MEDLINE, EMBASE, and CENTRAL databases, until 30th August 2022, was executed. Randomized controlled trials and observational studies (published between 2000-2022), with ≥5 patients, reporting on technical success, 30-day mortality and mortality during the available follow-up among patients that underwent PETTICOAT or STABILISE technique for acTBAD were eligible. The Newcastle-Ottawa Scale was applied to assess the risk of bias. Primary outcomes were technical success and 30-day mortality, and secondary outcome was mortality during the available follow-up. Results: Thirteen studies were considered eligible, twelve in the quantitative analysis. In total, 418 patients with acTBAD managed with the PETTICOAT (83%) or STABILISE (17%) technique were included. Technical success ranged between 97-100%, 99% for the PETTICOAT and 100% for the STABILISE sub-cohort. Thirty-day mortality was estimated at 3.7% (12/321), 1.4% for the STABILISE and 4.4% for the PETTICOAT technique. All studies reported the mean available follow-up which was estimated at 20 months (range 3-168 months), 22 months (mean value) for the PETTICOAT and 17 months (mean value) for the STABILISE technique. Twenty-three patients died during follow-up, with an estimated mortality rate at 5.7% for the total cohort. The mortality during follow-up was 0% for the STABILISE and 7.0% for the PETTICOAT approach. Conclusions: Both, the PETTICOAT and STABILISE techniques presented less than 4% perioperative mortality in patients with acTBAD with high technical success rate. The mid-term mortality rate was at 6%. However, the heterogeneity in the available studies' highlights the need for further prospective studies, including larger volume and longer follow-up.

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“…Finally, a dissection stent (ZDES-36-120, Cook) was placed in the terminal abdominal aorta to seal the dissection, according to the STABILISE technique. 4,5 The aneurysmal LSA was then excluded using a18 mm Amplatzer Vascular Plug II (St. Jude Medical Inc., St Paul, MN, USA), released through a bypass access, in the pre-vertebral portion. The final completion angiography showed complete exclusion of the aneurysmal degeneration, patency of all supra-aortic branches, and resolution of the narrowing at the level of the CoA site (Figure 2).…”

Section: Case Reportmentioning

confidence: 99%

Hybrid Surgical Approach to a Giant Post-Coarctation Aortic Aneurysm

et al. 2021

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Purpose: To report a rare case of giant aortic coarctation (CoA)-related descending thoracic aneurysmal degeneration, complicated by an acute aortic dissection. Case Report: A 57-year-old man referred with acute chest pain to the emergency department. A computed tomography angiography (CTA) revealed a CoA with a giant post-stenotic descending thoracic aneurysm (14 cm) and a concomitant left subclavian artery (LSA) aneurysm, complicated by an acute type B aortic dissection. A single-stage hybrid procedure was planned in an urgent setting. Initially, a left common carotid-to-left subclavian artery (LCCA-LSA) bypass was performed to gain a suitable proximal landing zone, the procedure was then completed with 3 thoracic endografts and 1 aortic dissection stent through a percutaneous femoral approach. The patient was discharged in postoperative day 8th without complications; the CTA performed at 1 month demonstrated patency of supra-aortic and visceral vessels, dilation of CoA site and exclusion of the false lumen. Conclusions: CoA is a congenital malformation rarely found in adults that may represent a challenge for the surgeon, especially when combined with a complication like an acute aortic dissection. This case shows that a hybrid approach is a safe and feasible treatment option even in such complex anatomies.

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New technical approach for type B dissection: from the PETTICOAT to the STABILISE concept

Cited by 17 publications

References 18 publications

One-Year Single-Center Results of the Multilayer Flow Modulator Stents for the Treatment of Type B Aortic Dissection

One-Year Single-Center Results of the Multilayer Flow Modulator Stents for the Treatment of Type B Aortic Dissection

A Systematic Review on PETTICOAT and STABILISE Techniques for the Management of Complicated Acute Type B Aortic Dissection

Hybrid Surgical Approach to a Giant Post-Coarctation Aortic Aneurysm

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