Satisfactory Long-term Outcomes of Thoracic Endovascular Aortic Repair With a Bare Stent for Acute Complicated Type B Aortic Dissections

Abstract

Purpose To compare the clinical outcomes after thoracic endovascular aortic repair (TEVAR) with a bare stent to those after TEVAR alone in patients with complicated acute type B aortic dissection (cATBAD). Materials and Methods A prospective, randomized trial was conducted at 2 medical centers in China between 2010 and 2013. Patients with cATBAD were randomly assigned to receive TEVAR with a bare stent (n=42) or TEVAR only (n=42). Patients were scheduled to undergo computed tomography angiography at 3, 6, and 12 months and then annually to 5 years. The primary endpoint was all-cause mortality at 5 years; secondary outcomes were a composite of complications (endoleak, stent-graft–induced new entry, aortic rupture, and secondary intervention) and aortic remodeling at 1 and 5 years. Results All-cause death occurred in 1 (2.4%) patient in the TEVAR with bare stent group (lung cancer) and 5 patients (11.9%) in the TEVAR group (4 aorta-related) during the 5-year follow-up (log-rank p=0.025). The 1- and 5-year rates of complications and secondary interventions did not differ between the groups. Patients in the TEVAR with bare stent group had higher increases in the thoracic true lumen diameter (19.7±3.6 vs 17.0±6.2 mm, p=0.018) and abdominal true lumen diameter (13.7±4.8 vs 7.2±6.1 mm, p<0.001) and a higher incidence of complete false lumen thrombosis (80.9% vs 47.6%, p=0.005) at the 1-year follow-up. However, no between-group differences in the changes of aortic remodeling parameters were observed between the 1- and 5-year follow-up periods. Conclusion The addition of a distal bare stent to a thoracic stent-graft during TEVAR was associated with significantly improved long-term survival in cATBAD patients vs TEVAR only, likely due to the prevention of true lumen collapse and improvement of complete false lumen thrombosis of the dissected aorta.

Clinical Results and Aortic Remodeling After Endovascular Treatment for Complicated Type B Aortic Dissection With the “Fabulous” Stent System

“…We first evaluated the patients' FL thrombosis and entry flows based on the CTA results according to the standard of previous researches ( 6 , 13 , 14 ). At the same time, the maximum diameters of the patients' thoracic and abdominal aorta were measured.…”

Long-Term Outcomes of Endovascular Repair of Thoracic Aortic Aneurysms

“…A recent RCT evaluated the outcomes with standard TEVAR versus TEVAR with bare metal stent (BMS). 41 This prospective study performed at two centers in China between 2010 and 2013 randomized 84 patients with acute complicated TBAD to receive TEVAR or TEVAR with BMS. During 5 years of follow-up, there was a single death (2.4%) in the TEVAR-BMS group versus 5 deaths (11.9%) in the TEVAR group.…”

The Rate of Postoperative Complications in Complicated Acute, and Subacute Type B Aortic Dissections after TEVAR vs. PETTICOAT Procedures: Systematic Review and Meta-Analysis

“…In this meta-analysis were included patients with acute and subacute type B aortic dissection, without a chronic type. In two studies, the patients with acute and subacute types constituted one group [2,3], while in the remaining research only patients with acute type B aortic dissection were included [9,21,22]. More detailed information regarding the mean interval time to operation was provided in two studies [2,3].…”

“…Patients who underwent conventional TEVAR waited fewer days for an operation; however, in only one study was the result statistically significant [3]. Lin et al [22] conducted a prospective and randomized study, while the remaining four were retrospective. The sample sizes ranged between 33 and 148.…”

“…The included studies were conducted between 2018 and 2021. Two studies were performed in Japan [2,3], two in China [21,22], and one in the United States [9]. In all studies, patients with type B aortic dissection were included according to the Standford classification.…”