What is the clinical evidence from this study?

Study design: Observational. Population: Acute aortic dissection with end-organ ischemia (n=36). Intervention: Endovascular uncovered stent implantation vs. Baseline. Primary outcome: Minimal true lumen diameter (mm) (95% CI 12.45-21.34, p=<0.001).

What question did this study set out to answer?

To evaluate aortic remodeling, lumen dimensions, and clinical outcomes after implanting uncovered stents to treat complex type A or type B aortic dissections.

April 27, 2023Reviews in Cardiovascular MedicineOpen Access

Endovascular Treatment of Complex Aortic Dissection. A Single Center 5 Years' Experience with 36 Patients

Q: What are the key findings of this study?

Endovascular treatment with non-covered stents for complex aortic dissection significantly increased the mean minimal true lumen diameter from 10.55 mm to 27.38 mm and achieved a 0% mortality rate.

Q: What question did this study set out to answer?

To evaluate aortic remodeling, lumen dimensions, and clinical outcomes after implanting uncovered stents to treat complex type A or type B aortic dissections.

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Key result

Non-covered stenting for complex aortic dissection linked to a ~160% increase in true lumen diameter.

95% CI 12.45-21.34
P<0.001
n=36

Why the study?

The study aimed to evaluate aortic remodeling, false lumen depressurization, and true lumen expansion using non-covered stent implantation in complex type A or B aortic dissection.

Does endovascular uncovered stent implantation improve aortic remodeling and survival in patients with acute aortic dissection and end-organ ischemia?

Population

36 patients with acute aortic dissection and end-organ ischemia due to true lumen compression

Comparison

Endovascular uncovered stents implantation preceded or not by stent-graft implantation or surgical treatment

Design

Single-center case series with prospective data collection and retrospective analysis

Follow-up

At least 1 year

Authors

IPIvo PetrovKarolinska University Hospital ZSZoran StankovAcibadem City Clinic SVStrahil VasilevAcibadem City Clinic

Discussion

Member takes

Implication

Supports further investigation of uncovered stents in malperfusion; should not yet change practice pending prospective trials.

Key Points

To evaluate aortic remodeling, lumen dimensions, and clinical outcomes after implanting uncovered stents to treat complex type A or type B aortic dissections.
Retrospective analysis of prospectively recorded data from 36 consecutive patients treated between 2014 and 2018 for acute aortic dissection complicated by true lumen compression and end-organ ischemia.
Patients underwent endovascular deployment of uncovered stents in the aorta and involved branch vessels, with or without previous stent-grafts or surgical repair.
Computed tomography angiography was performed before treatment and at least one year post-intervention to assess branch patency and true versus false lumen diameters.
Computed tomography angiography at minimum one-year follow-up demonstrated statistically significant improvements in true and false lumen diameters alongside patent stents in all patients.
All 36 patients experienced symptomatic relief, with 0% aorta-related mortality and 0% overall mortality.

Study Design

Type

Observational (n=36)

Multicenter

Structured PICO

Does endovascular uncovered stent implantation improve aortic remodeling and survival in patients with acute aortic dissection and end-organ ischemia?

Population

36 patients with acute aortic dissection (12 type A, 24 type B) and end-organ ischemia due to true lumen compression, mean age 53.39 years, 88.8% male.

Intervention

Endovascular uncovered stents implantation (preceded or not by stent-graft implantation or surgical treatment) in the aorta and affected side branches.

Outcome

Induction of aortic remodeling by depressurization of the false lumen and increasing the size of the true lumen.surrogate

Main Result

Absolute Event Rate: 27.38% vs 10.55%

p-value: p=<0.001

Endovascular treatment with uncovered stents for complex aortic dissection with malperfusion is safe, induces positive aortic remodeling, and is associated with excellent survival.

Limitations

Small sample size
Potential survival bias due to patient transfers from other facilities
relatively small sample size
potential survival bias due to patient transfer from other facilities

Cite This Study

Petrov et al. (2023) conducted an observational in Acute aortic dissection with end-organ ischemia (n=36). Endovascular uncovered stent implantation vs. Baseline was evaluated on Minimal true lumen diameter (mm) (95% CI 12.45-21.34, p=<0.001). Endovascular treatment with non-covered stents for complex aortic dissection significantly increased the mean minimal true lumen diameter from 10.55 mm to 27.38 mm and achieved a 0% mortality rate.

synapsesocial.com/papers/6a0d7b451e1a6dfdb4ba97ba https://doi.org/10.31083/j.rcm2405133

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Endovascular Treatment of Complex Aortic Dissection. A Single Center 5 Years' Experience with 36 Patients

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Endovascular Treatment of Complex Aortic Dissection. A Single Center 5 Years' Experience with 36 Patients

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider