Effectiveness of a Stent System Based on the “PETTICOAT” Technique in Distal Aortic Remodeling for Type B Aortic Dissection—A “Matching” Comparative Study

This study aimed to compare the aortic remodeling of distal aorta after the traditional thoracic endovascular aortic repair (TEVAR) with the "Fabulous" stent system repair, a new two-stage stent system based on the PETTICOAT technique. The prospective data were collected between December 2017 and October 2019 from 134 patients with type B aortic dissection (TBAD) who underwent treatment with the "Fabulous" stent system, as well as data from 159 TBAD patients who underwent standard TEVAR from the corresponding multicenter. By using propensity score matching analysis, we compared the incidence of complications and aortic remodeling outcomes in patients undergoing Fabulous stent system and standard TEVAR treatments during a 1-year postoperative follow-up. By using propensity score matching analysis, 62 patients in the Fabulous group and 62 patients in standard TEVAR were included in the analysis; there were no significant statistical differences in baseline characteristics (Table I). In terms of aortic remodeling in the bare stent region, the Fabulous group had better change trends of true lumen and false lumen than those in the standard TEVAR group (9.6 ± 7.4 mm vs 5.2 ± 7.2 mm, P = .001, minimum diameter changes of true lumen; −19.1 ± 15.1 mm vs −5.5 ± 13.2 mm, P < .001, maximum diameter changes of false lumen), and rate of false lumen thrombosis was also better in the Fabulous group (62.9% vs 37.1%, P = .042) (Table II and Fig). Through propensity score matching analysis, the Fabulous stent system, when compared with standard TEVAR surgery, demonstrates good aortic remodeling outcomes in the distal aorta without increasing the incidence of complications.Table IBaseline characteristics in type B aortic dissection (TBAD) patients treated between the standard thoracic endovascular aortic repair (TEVAR) and fabulous before and after propensity score matching analysisCharacteristicsUnadjusted populationPropensity matching analysis populationStandard TEVAR (n = 159)Fabulous (n = 134)PStandard TEVAR (n = 62)Fabulous (n = 62)PAge,years, mean ± SD53.9 ± 13.254.7 ± 12.5.6355.7 ± 12.855.9 ± 11.7.78Male, No. (%)129 (81.3)119 (88.8).09850 (80.6)53 (85.5).63Hypertension, No. (%)115 (72.3)113 (84.3).0251 (82.349 (79.0).82Hyperlipidemia, No. (%)13 (8.2)11 (8.2).9925 (8.1)5 (8.1).63Diabetes, No. (%)11 (6.9)10 (7.5).8575 (8.1)6 (9.7).50CAD, No. (%)17 (10.7)5 (3.7).0424 (6.5)4 (6.5).64History of smoking, No. (%)60 (37.7)71 (53.0).01330 (48.4)30 (48.4).57Dissection involvement, No. (%) Descending aorta61 (38.4)77 (57.5).00129 (46.8)35 (99.7).37 Abdominal aorta159 (100)133 (99.3)<.00162 (100)61 (98.4).50 Iliac aorta149 (93.7)113 (84.3).00954 (87.1)54 (87.1).61Aortic dimensionsBare stent segment, mean ± SD Minimum diameter of TL, mm13.53 ± 4.7913.27 ± 6.55.713.5 ± 5.312.9 ± 6.2.23 Maximum diameter of FL, mm28.51 ± 4.6928.97 ± 8.34.55528.5 ± 5.630.3 ± 6.7.03 Aortic diameter, mm32 ± 5.6533.59 ± 6.04.0232.6 ± 6.533.5 ± 6.3.24 TL area, mm22.32 ± 1.012.55 ± 1.5.1232.5 ± 1.22.3 ± 1.2.17 Total lumen area, mm27.36 ± 2.418.78 ± 2.93<.0018.1 ± 3.08.5 ± 2.9.16Distal bare stent segment, mean ± SD TL diameter, mm13.47 ± 5.2613.81 ± 5.71.59313.2 ± 6.213.6 ± 5.8.54 FL diameter, mm15.63 ± 7.9413.24 ± 7.69.0113.6 ± 8.014.5 ± 7.6.78 TL area, mm22.15 ± 0.992.49 ± 1.34.0112.3 ± 1.22.4 ± 1.3.65 Total lumen area, mm25.64 ± 1.636.08 ± 1.71.0275.8 ± 1.96.3 ± 2.1.12CAD, Coronary artery disease; FL, false lumen; SD, standard deviation; TL, true lumen. Open table in a new tab Table IIThe postoperation characteristics and aortic dimensions at 1-year follow-up between the standard thoracic endovascular aortic repair (TEVAR) and FabulousComplications and outcomes of aortic remodelingVariableStandard TEVAR (n = 62)Fabulous (n = 62)PReintervention4 (6.5)0 (0).042SINE3 (4.8)0 (0).080Type I endoleak7 (11.3)8 (12.9).783Type II endoleak2 (3.2)5 (8.1).243Aortic dimensions Bare stent segmentMinimum diameter of TL, mm18.8 ± 6.322.6 ± 5.6.001Changes of minimum diameter of TL, mm5.2 ± 7.29.6 ± 7.4.001Maximum diameter of FL, mm22.9 ± 12.611.2 ± 14.1<.001Changes of maximum diameter of FL, mm−5.5 ± 13.2−19.1 ± 15.1<.001TL area, mm23.8 ± 1.64.8 ± 1.7<.001Changes of TL area, mm21.3 ± 1.32.5 ± 1.6<.001Total lumen area, mm28.8 ± 3.67.5 ± 3.5.004Changes of total lumen area, mm20.8 ± 2.8−1.0 ± 2.4.723TL area/total lumen area0.52 ± 0.40.74 ± 0.3<.001 Distal bare stent segmentTL diameter, mm15.6 ± 5.417.4 ± 5.4.044Changes of TL diameter, mm2.4 ± 5.43.7 ± 4.5.133FL diameter, mm16.5 ± 9.711.5 ± 10.0.008Changes of FL diameter, mm3.1 ± 7.3−2.9 ± 7.1<.001TL area, mm22.8 ± 1.13.5 ± 1.3.001Changes of TL area, mm20.5 ± 0.91.1 ± 1.0.001Total lumen area, mm27.1 ± 2.66.6 ± 3.1.118Changes of total lumen area, mm21.3 ± 1.70.2 ± 2.8.007TL area/total lumen area0.45 ± 0.30.66 ± 0.4<.001False lumen thrombosis in the bare stent area Patent26 (41.9)0.0 (0.0).048 Partial thrombosis13 (21.0)23 (37.1).004 Complete thrombosis23 (37.1)39 (62.9).042FL, False lumen; TL, true lumen.Data are presented as mean ± standard deviation and number (%). 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