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Aortic Remodeling After Endovascular Treatment of Complicated Type B Aortic Dissection With the Use of a Composite Device Design
Study Questions:
What are the outcomes of a composite device for treatment of complicated type B aortic dissection?
Methods:
STABLE (Study for the Treatment of complicated Type B Aortic Dissection using Endoluminal repair) is a prospective nonrandomized multicenter study, which evaluated outcomes of a composite device that excludes entry tears using an endograft and provides intimal support to the remaining aorta with an uncovered bare-metal stent that permits flow to side branches. This manuscript provides 2-year follow-up results for the 86 enrolled patients with type B aortic dissection, complicated by branch vessel compromise, impending rupture, resistant hypertension, persistent symptoms, or rapid growth. Mortality and aorta remodeling were examined.
Results:
Mean age was 59 years, and 73% were men. From the total cohort of 86 patients, 55 were treated during the acute phase (within 14 days), and 31 were treated in the nonacute phase. Freedom from all-cause mortality was 88% at 1 year and 85% at 2 years, and there were no differences between acute and nonacute patients. Between baseline and 2 years, there was an increase in complete thrombosis (thoracic aorta 0% vs. 44%, abdominal aorta 1% vs. 13%) and variable changes in partial thrombosis (thoracic aorta 61% vs. 57%, abdominal aorta 38% vs. 74%) of the false lumen. Between baseline and 2 years, there was a significant increase in true lumen size and decrease in false lumen size for patients treated during acute and nonacute phases. At 2 years, the total aortic diameter remained stable in the thoracic aorta in 74%, and the abdominal aorta in 67%. Patients treated during acute (vs. nonacute) phases were more likely to have >5 mm increase in diameter in the abdominal aorta (47% vs. 7%, p = 0.008), with a trend to an increase in the thoracic aorta diameter (36% vs. 7%, p = 0.07). On multivariable analysis, only a shorter time from symptom onset to treatment was independently associated with increased abdominal aorta diameter (p = 0.03).
Conclusions:
This study observes favorable aortic remodeling following treatment of complicated type B aortic dissection with a composite device. Patients treated with this device within 2 weeks of symptom onset were more likely to have an increase in total aortic size during follow-up.
Perspective:
This study observed good short-term outcomes in patients with complicated type B aortic dissection using a composite device that includes an endograft to exclude entry tears and an uncovered bare-metal stent to provide intimal support and preserve flow to side branches. On average, patients had favorable remodeling of the aorta, with increased true lumen size and decreased false lumen size. However, patients treated within 14 days of symptom onset had a higher likelihood of expansion of the total aorta size at 2 years as compared to those treated later. While no differences in 2-year mortality were observed between groups, longer-term follow-up is needed to identify if these changes continue, and whether these patients have differences in longer-term outcomes.
Keywords: Aortic Aneurysm, Thoracic, Thrombosis, Angioplasty, Hypertension, Stents
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