Christoph A Nienaber1, Xun Yuan2, Mohamad Aboukoura3, Philip Blanke4, Rudolf Jakob5, Rolf Alexander Janosi6, Luigi Lovato7, Vincent Riambau8, Jaroslaw Trebacz9, Santi Trimarchi10, Burkhart Zipfel11, Jos C van den Berg12. 1. Department of Cardiology, University Hospital Rostock, Rostock, Germany; Cardiology and Aortic Centre, Royal Brompton and Harefield Hospital, Harefield, United Kingdom; Department of Cardiology, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom. Electronic address: c.nienaber@rbht.nhs.uk. 2. Cardiology and Aortic Centre, Royal Brompton and Harefield Hospital, Harefield, United Kingdom; Department of Cardiology, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom. 3. Department of Cardiology, University Hospital Rostock, Rostock, Germany. 4. Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 5. Department of Vascular Medicine, University Hospital Augsburg, Augsburg, Germany. 6. Department of Cardiology, West German Heart Center Essen, Essen, Germany. 7. Department of Cardiovascular Radiology, S. Orsola-Malpighi Hospital, Bologna, Italy. 8. Vascular Surgery Division, Hospital Clínic, University of Barcelona, Barcelona, Spain. 9. Institute of Cardiology, Jagiellonian University, Kraków, Poland. 10. Thoracic Aortic Research Centre, IRCCS-Policlinico San Donato, University of Milan, Milan, Italy. 11. Department of Cardiothoracic Surgery, German Heart Institute Berlin, Berlin, Germany. 12. Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland.
Abstract
BACKGROUND: The ASSIST (A multicentre Study in Survivors of type B aortic dissection undergoing Stenting) study compared both 1-year outcomes and evolution of true and false lumen (eg, remodeling) in patients with complicated type B aortic dissection subjected to thoracic endovascular aortic repair (TEVAR) with distal true lumen scaffolding by self-expanding nitinol open stent in comparison with TEVAR alone. METHODS: The ASSIST study was a multicenter prospective single-arm study comparing clinical and imaging data from 39 consecutive patients (59.4 ± 13 years of age) who received TEVAR and the JOTEC E-XL open stent with data from matched control subjects treated with TEVAR alone based on 1:1 propensity score matching. Clinical data were collected by an independent Contract Research Organization (CRO) and computed tomography images were subjected to blinded core-lab analysis. RESULTS: There were no differences in baseline demographics, clinical profiles, morphological data, procedural details, and in-hospital and 1-year outcomes between groups. Differences emerged with regard to evolution of both true lumen distal to stent graft, false lumen over the entire length of dissection, and remodeling (P < .001). At 1 year, TEVAR with the E-XL stent revealed false lumen thrombosis at the level of celiac trunk in 53.8% vs 17.9% with TEVAR alone (P = .004). Kaplan-Meier survival analysis indicated favorable clinical outcomes with the additional E-XL stent. CONCLUSIONS: TEVAR for acute complicated type B aortic dissection proved to be safe and promoted remodeling of the stent grafted thoracic aorta. Additional scaffolding of the true lumen distal to TEVAR with a self-expanding stent supported distal true lumen expansion, false lumen regression, and thrombosis, with evidence of improved distal remodeling at 1 year.
BACKGROUND: The ASSIST (A multicentre Study in Survivors of type B aortic dissection undergoing Stenting) study compared both 1-year outcomes and evolution of true and false lumen (eg, remodeling) in patients with complicated type B aortic dissection subjected to thoracic endovascular aortic repair (TEVAR) with distal true lumen scaffolding by self-expanding nitinol open stent in comparison with TEVAR alone. METHODS: The ASSIST study was a multicenter prospective single-arm study comparing clinical and imaging data from 39 consecutive patients (59.4 ± 13 years of age) who received TEVAR and the JOTEC E-XL open stent with data from matched control subjects treated with TEVAR alone based on 1:1 propensity score matching. Clinical data were collected by an independent Contract Research Organization (CRO) and computed tomography images were subjected to blinded core-lab analysis. RESULTS: There were no differences in baseline demographics, clinical profiles, morphological data, procedural details, and in-hospital and 1-year outcomes between groups. Differences emerged with regard to evolution of both true lumen distal to stent graft, false lumen over the entire length of dissection, and remodeling (P < .001). At 1 year, TEVAR with the E-XL stent revealed false lumen thrombosis at the level of celiac trunk in 53.8% vs 17.9% with TEVAR alone (P = .004). Kaplan-Meier survival analysis indicated favorable clinical outcomes with the additional E-XL stent. CONCLUSIONS:TEVAR for acute complicated type B aortic dissection proved to be safe and promoted remodeling of the stent grafted thoracic aorta. Additional scaffolding of the true lumen distal to TEVAR with a self-expanding stent supported distal true lumen expansion, false lumen regression, and thrombosis, with evidence of improved distal remodeling at 1 year.
Authors: Jim Zhong; Ahmed Osman; Costa Tingerides; Sapna Puppala; David Shaw; Simon McPherson; Rosemary Darwood; Paul Walker Journal: Cardiovasc Intervent Radiol Date: 2021-01-03 Impact factor: 2.740
Authors: Isaac Wamala; Mir Timo Zadegh Nazari-Shafti; Roland Heck; Adam Penkalla; Matteo Montagner; Steven J Staffa; Volkmar Falk; Semih Buz Journal: Interact Cardiovasc Thorac Surg Date: 2022-10-10