Key result
Sizing distal TEVAR stents to estimated normal aorta is linked to full remodeling in TBAD.
Why the study?
Does selecting distal stent size based on estimated normal aorta size improve aortic remodeling and reduce distal SINE in patients undergoing TEVAR for type B aortic dissection?
Cohort (n=90)
Does selecting distal stent size based on estimated normal aorta size improve aortic remodeling and reduce distal SINE in patients undergoing TEVAR for type B aortic dissection?
Selecting distal stent size based on estimated normal aorta size promotes full aortic remodeling and reduces the risk of distal stent graft-induced new entry after TEVAR for type B aortic dissection.
Answers are grounded in this paper and cite their sources.
May support normal-aorta-based distal sizing in TEVAR; hypothesis-generating for remodeling benefits, pending prospective validation.
OBJECTIVES: Tapered stent graft has been used to reduce distal stent graft-induced new entry (SINE), but there is no solid evidence for distal size selection about grafting in the dissected distal landing zone. We aimed to estimate the distal stent size based on the estimated normal aorta before dissection onset and remodeling after thoracic endovascular aortic repair (TEVAR) in the study. METHODS: Patients received TEVAR from July 2016 to June 2024 were regrouped into 3 groups based on differentials between estimated distal stent size and actual distal stent size (group A: differentials within 0-1 mm; group B: actual distal stent size smaller than estimated distal stent size, differentials >1 mm; group C: actual distal stent size larger than estimated distal stent size, differentials >1 mm). Remodeling condition was divided into full remodeling (complete false lumen reduction), complete false lumen thrombosis, and non-remodeling. Clinical and morphological data were collected and analyzed. Risk factors of full remodeling and survival data were determined and evaluated. RESULTS: Ninety patients were included in this study. Full remodeling was significantly satisfied in group A (78.1%) than in group B (21.4%) and group C (46.7%, p<0.05). Distal SINE was significantly higher in group C (13.3%) than group A (0%) and group B (0%, p<0.05). The cumulative 5-year full remodeling rate was significantly higher in group A than in group B and group C (p<0.05). Multivariate Cox regression analysis revealed that differentials between estimated distal stent size and actual distal stent size were a significant predictive factor of full remodeling after TEVAR (p<0.05). CONCLUSION: Distal stent size selected by estimated normal aorta size could promote full remodeling at the dissected aorta after TEVAR, with low risk of distal SINE.Clinical ImpactDistal stent size selected by estimated normal aorta size could promote aortic remodeling and false lumen complete reduction (full remodeling) at stented section after endovascular therapy in type B dissection patient.
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Zhao et al. (2026) conducted a cohort in Type B Aortic Dissection (n=90). Distal stent size matching estimated normal aorta size (0-1 mm differential) vs. Distal stent size smaller or larger than estimated normal aorta size (>1 mm differential) was evaluated on Full remodeling (complete false lumen reduction) (p=<0.05). Selecting distal stent size based on estimated normal aorta size (0-1 mm differential) achieved significantly higher full remodeling (78.1%) compared to smaller (21.4%) or larger (46.7%) stents (p<0.05).
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