G.B. Rodriguez1,2, J. Goldberg3, L. Le1,4, I. Laskowski1,2 1Westchester Medical Center, Surgery, Valhalla, NY, USA 2New York Medical College, Valhalla, NY, USA 3Weill Cornell Medicine/New York Presbyterian Hospital, Surgery, New York, NY, USA 4State University Of New York At Buffalo, Jacobs School Of Medicine, Buffalo, NY, USA
Introduction:
The increase in thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBAD) has been observed with the goal to achieve positive aortic remodeling through true lumen (TL) expansion and false lumen (FL) thrombosis. The STABILISE technique, involving stent-assisted balloon-induced intimal disruption and prelamination in aortic dissection, has been proposed to address suboptimal aortic remodeling observed with the provisional extension to induce complete attachment (PETTICOAT technique). Accurate assessment of FL and TL changes is critical for determining the effectiveness of stenting and patient outcomes. Previously, we demonstrated that 3D volumetric measurements are superior to 2D diameters for assessing the lumen in aortic dissection. Here, we present midterm aortic remodeling in TBAD patients treated at a single institution using 3D volume measurements.
Methods:
Comparisons of pre- and post-intervention volumetric measurements of five consecutive patients treated with the PETITCOAT and STABILISE technique were obtained using the 3D Slicer program with a focus on the thoracic and abdominal aorta represented by Ishimura zones 3 to 5 and zones 6 to 9. Changes in TL and FL between techniques using an independent samples Wilcoxon test and within technique using a paired samples t-test were performed. Normality assumptions confirmed for these analyses.
Results:
Between the two techniques analysis using Wilcoxon test revealed that in zones 3 to 5 post-intervention TL was significantly larger in the STABILISE group compared to PETITCOAT (p = 0.032). Additionally, although not statistically significant, there was a trend towards a smaller FL in the STABILISE group post-intervention compared to PETITCOAT (p = 0.056). In zones 6 to 9, no significant differences between the techniques were observed.
Within the technique t-test results showed significant increases in TL post-intervention in the STABILISE technique compared to PETITCOAT in all zones. In zones 3 to 5 and zones 6 to 9, the mean increase in TL was 133.84 cm³ (p = 0.001) compared to 82.95 cm³ (p = 0.006)., and 30.42 cm³ (p = 0.027) compared to 8.28 cm³ (p = 0.006) for STABILISE compared to PETITCOAT respectfully. Additionally, STABILISE resulted in significant reductions in FL post-intervention for in all zones, with mean reductions of 78.66 cm³ (p < 0.001) and 28.80 cm³ (p = 0.011) in zones 3 to 5 and 6 to 9, with no statistically significant FL reduction in the PETITCOAT group.
Conclusion:
3D volume measurements showed that STABILISE technique for aortic dissection achieves significantly better positive aortic changes compared to PETITCOAT expressed by TL increase and FL decrease across all aortic treatment zones. Aortic volume rather than two-dimensional measurements is an applicable technique that may more accurately evaluate remodeling in patients undergoing TEVAR.