STABILISE technique provides superior aortic remodeling compared to PETTICOAT technique for Type B aortic dissection in an early follow up period.

J. Goldberg¹, G. Rodriguez², D. Samson², R. Mateo², S. Ohira², D. Spielvogel², I. Laskowski^2
1Westchester Medical Center, White Plains, New York ²Westchester Medical Center, Valhalla, New York

Purpose: Recently, an increase in thoracic endovascular aortic repair (TEVAR) of type B aortic dissections (TBAD) has been observed with the goal of true lumen (TL) expansion, false lumen (FL) thrombosis and positive aortic remodeling. Variability of TEVAR strategies have been reported with few comparative studies.

Methods: Consecutive, complicated TBAD patients with FL extending into the abdominal aorta who were treated with TEVAR between 2019-2022 at a single center were studied. Two TEVAR strategies were compared. Both strategies entailed deployment of covered stents in the descending thoracic aorta and uncovered stents in the abdominal aorta. The STABILSE technique (stent-assisted balloon-induced intimal disruption and relamination in aortic dissection) includes ballon aortoplasty of the covered and uncovered stents to facilitate positive aortic remodeling. The PETTICOAT technique (provisional extension to induce complete attachment) did not involve balloon aortoplasty. Aortic remodeling was assessed by comparing preTEVAR and postTEVAR (prior to discharge) TL and FL diameters at the largest segment in aortic zones 4, 5 or 6. Secondary endpoints included inpatient aortic rupture, spinal cord ischemia, retrograde type A dissection, open conversion, and new aortic branch vessel compromise.

Results: 17 patients were analyzed (6 PETTICOAT and 11 STABILISE). Demographics, comorbidities and surgical indications were similar between cohorts. Intracohort comparison of preTEVAR and postTEVAR TL and FL measurements was performed. Among PETTICOAT patients there was no significant increase in TL diameter postTEVAR [preTEVAR 25.2mm± 5.9 vs postTEVAR 28.5mm ± 5.4 with a mean difference of 3.2mm ± 6.6 (p=0.3)]. Additionally, there was no significant decrease in FL diameter [preTEVAR 21.0mm ± 5.4; postTEVAR 18mm ± 3.6, mean difference -3.0mm ±7.4 (p= 0.4)]. In contrast, a significant increase in TL diameter was observed in postTEVAR STABILSE patients [preTEVAR 25.5mm ± 6.5; postTEVAR 33.2mm ± 4.3; mean difference 7.8mm ± 8.2 (p=0.005)] and significant reduction if FL diameter [preTEVAR 24.1mm ± 5.9; postTEVAR 9.8mm ± 9.3; mean difference -14.3mm ± 8.3 (p < 0.001). While preTEVAR TL and FL were similar between cohorts, STABILSE patients demonstrated superior positive aortic remodeling with significantly increased TL and decreased FL diameters postTEVAR when compared to PETTICOAT patients. (Table and Figure) All patients survived to discharge, with no paraplegia, aortic rupture, myocardial infarction or need for dialysis. One retrograde Type A occurred in a STABILISE patient on POD 5 which was successfully repaired.

Conclusion: Few studies compare endovascular strategies used to treat TBAD. This single center series demonstrates improved early aortic remodeling with the STABILSE technique after TBAD when compared to the PETTICOAT technique.

Identify the source of the funding for this research project: No funding