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Midterm Results After Endovascular Treatment of Acute, Complicated Type B Aortic Dissection: The Talent Thoracic Registry
Study Questions:
What are the outcomes following endovascular stent repair in patients with acute complicated type B aortic dissections?
Methods:
This study examined outcomes in 29 patients with acute complicated type B aortic dissections treated with the Medtronic Talent thoracic stent graft (Medtronic/AVE, Santa Rosa, CA). This study evaluated a subset of patients from the Talent Thoracic Registry, which collects data on 457 consecutive patients treated with this stent graft at seven sites and with at least 1 year of follow-up.
Results:
Mean age was 61 years; 76% were men. Indications for intervention were malperfusion (n = 17), aortic rupture (n = 5), persistent pain (n = 5), or refractory hypertension (n = 2). All cases were technically successful, with coverage proximal to the entry tear in all cases. An early type Ia endoleak occurred in four patients (15%), and neurologic complications were observed in three patients (10%), including two strokes and one transient ischemic attack. There were five hospital deaths (17%), including two deaths during the procedure, and three post-procedural deaths (one aortic rupture and two cases of multi-organ failure). In the 25 patients surviving to discharge, mean follow-up was 53 ± 41 months; late mortality was noted in 25% (6/24) of individuals, with two deaths aorta-related and four due to other causes. Freedom from graft failure (reintervention, aortic rupture, graft-related complication, aorta-related death, or unexplained sudden death) was 82% at 1 year and 77% at 5 years.
Conclusions:
The authors concluded that use of endovascular thoracic stent grafts in acute complicated type B aortic dissection may represent a feasible and effective means of acute treatment.
Perspective:
While medical therapy appears to represent an optimal initial approach in patients with uncomplicated type B aortic dissection, there is increasing interest in the use of endovascular thoracic stent grafts to treat complicated type B dissections given their potential ability to close proximal intimal tears, direct blood into the true lumen, induce thrombosis of the false lumen, and improve flow through some side branches. The present study demonstrates a high rate of procedural success and a limited rate of aortic-related adverse events. Nevertheless, this is a small study that is limited to high-volume centers, and larger future studies are needed, including clinical trials to directly compare therapeutic alternatives in these patients.
Keywords: Follow-Up Studies, Aortic Aneurysm, Thoracic, Perioperative Care, Thrombosis, Cardiovascular Diseases, Death, Sudden, Hypertension, Stents
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