Early results of bare metal extension stent for thoracoabdominal aortic dissection

Patrick R Vargo; Christopher L Tarola; Emily Durbak; Chang Yoon Doh; Francis J Caputo; Christopher J Smolock; Eric E Roselli

doi:10.1016/j.xjtc.2022.04.011

Early results of bare metal extension stent for thoracoabdominal aortic dissection

JTCVS Tech. 2022 Apr 20:14:1-8. doi: 10.1016/j.xjtc.2022.04.011. eCollection 2022 Aug.

Authors

Patrick R Vargo^{1

2}, Christopher L Tarola³, Emily Durbak⁴, Chang Yoon Doh⁵, Francis J Caputo^{1

6}, Christopher J Smolock^{1

6}, Eric E Roselli^{1

2}

Affiliations

¹ Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
² Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
³ Division of Cardiac Surgery, Sunnybrook Health Science Center, University of Toronto, Toronto, Ontario, Canada.
⁴ Cleveland Clinic Lerner College of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
⁵ School of Medicine, Case Western Reserve University, Cleveland, Ohio.
⁶ Department of Vascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.

Abstract

Objectives: Debakey type I and IIIb aortic dissections are complicated by extension along the full length of the aorta. Over the long term, the thoracoabdominal aorta in these patients often continues to degenerate, requiring endovascular or open repair. The purpose of this investigation is to determine the early clinical outcome on aortic remodeling using a composite thoracic stent graft and thoracoabdominal bare metal extension stenting strategy.

Methods: From April 2019 to April 2021, 73 patients with Debakey I/IIIb aortic dissection underwent endovascular stent graft repair of the descending thoracic aorta and repair of the thoracoabdominal aorta using bare metal extension stenting. Preoperative and follow-up surveillance computed tomography imaging scans were analyzed.

Results: Fifty-three (73%) patients had a Debakey I aortic dissection, and 50 (69%) patients underwent surgery during the chronic (time to surgery >30 days) dissection phase. Mortality at 30 days was 4% (3 hyperacute patients). Stroke occurred in 3 (4%), paraparesis in 2 (2.7%), and acute renal failure requiring dialysis occurred in 2 (2.7%) patients. On postoperative and follow-up computed tomography, there was a significant increase in false lumen thrombosis (P < .001). This coincided with a significant increase in true lumen fraction suggestive of positive aortic remodeling (P < .001) at the time of latest follow-up.

Conclusions: Altering the course of aortic remodeling, with placement of a dissection stent in the thoracoabdominal aorta simultaneous with descending thoracic aortic repair may promote true lumen re-expansion and false lumen thrombosis during acute and chronic dissection phases.

Keywords: CT, computed tomography; PETTICOAT; PETTICOAT, Provisional Extension to Induce Complete Attachment; TEVAR; TEVAR, thoracic endovascular aortic repair; aortic aneurysm; aortic dissection; endovascular.