Key result
TEVAR within 14 days of acute type B dissection is linked to optimal late aortic remodeling.
Why the study?
The optimal timing of TEVAR after acute type B aortic dissection to achieve late aortic remodeling remained undetermined.
Does acute phase TEVAR improve late aortic remodeling compared to subacute or chronic phase TEVAR in patients with acute type B aortic dissection?
Cohort (n=48)
Does acute phase TEVAR improve late aortic remodeling compared to subacute or chronic phase TEVAR in patients with acute type B aortic dissection?
Performing TEVAR within 14 days of acute type B aortic dissection onset is associated with significantly better long-term aortic remodeling compared to delayed intervention.
May support earlier TEVAR timing for remodeling in acute type B dissection; leaves open confirmation in randomized trials.
Background: To determine the optimal timing of thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (TBAD), we investigated the relationship between the timing of TEVAR after onset and late aortic remodeling. Methods: Between March 2015 and August 2020, 48 patients with TBAD (39 men [81.2%]; aged 61.0 ± 10.6 years) underwent TEVAR in the acute phase (within 14 days; n = 23), subacute phase (15-90 days; n = 13), or chronic phase (>90 days; n = 12). These 3 groups were compared in terms of the true lumen (TL) area ratios, calculated by dividing the TL area by the aortic lumen area on the computed tomography image at 1 week, 1 year, 2 years, and 3 years after TEVAR. Results: At the distal-end level of the TEVAR stent, there were significant negative correlations between TEVAR timing and TL area ratio, and the cutoff value for the most effective TEVAR timing for late aortic remodeling was 14 and 8 days on the receiver operating characteristic curves with a TL area ratio of ≥80% at 1 year and 3 years after TEVAR, respectively. Conclusions: In patients with acute TBAD, acute phase TEVAR (within 14 days after onset) may be an optimal strategy to obtain sufficient aortic remodeling for a long-term postoperative period.
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Kiryu et al. (2023) conducted a cohort in Acute type B aortic dissection (TBAD) (n=48). Thoracic endovascular aortic repair (TEVAR) in the acute phase (within 14 days) vs. TEVAR in the subacute phase (15-90 days) or chronic phase (>90 days) was evaluated on True lumen (TL) area ratios at 1 week, 1 year, 2 years, and 3 years after TEVAR. TEVAR performed within 14 days of onset for acute type B aortic dissection optimized late aortic remodeling, with ROC cutoffs of 14 and 8 days for a true lumen area ratio ≥80% at 1 and 3 years.
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