One-year outcomes of thoracic endovascular stent graft repair for acute type B aortic penetrating ulcer combined with antiplatelet drugs

Objective The aim of this study was to investigate the 12—month clinical outcomes and 6—month morphological changes of acute penetrating aortic ulcers (PAUs) after thoracic endovascular aortic repair (TEVAR) combined with antiplatelet (AP) drugs. Methods Patients who underwent TEVAR for acute PAUs at the General Hospital of Northern Theater Command from January 2012 to June 2024 were included. Demographics, clinical data, and imaging characteristics were retrospectively collected. The primary outcome was major adverse events, defined as a composite of death, endoleak, aortic rupture or re-dissection, re-intervention, stroke, acute myocardial infarction, and hemorrhage (BARC ≥ 2 grade). Results Of the 195 patients, 59 were treated with AP drugs (AP group) and 136 without AP drugs (NAP group). There were no significant differences in preoperative demographic or imaging characteristics between the two groups. A total of 180 patients with acute PAUs underwent CTA reexamination within 6 months after TEVAR. At 6-month follow-up, the mean imaging parameters were as follows: aortic diameter at PAU, 32.44 ± 2.19 mm; PAU diameter, 1.83 ± 1.77 mm; PAU depth, 1.46 ± 0.96 mm; and intramural hematoma (IMH) thickness, 1.16 ± 1.03 mm. There were no significant differences in these aforementioned parameters between the AP and NAP groups. Compared with preoperative imaging parameters, neither group showed a significant difference in aortic diameter at PAUs; however, PAU diameter and depth were smaller in both the AP and NAP groups (all P < 0.001), and IMH thickness was also smaller in both groups (all P < 0.001). During 12-month follow-up, 31 patients (15.8%) experienced a primary outcome event. The cumulative incidence of major adverse events at 30 days and 12 months was higher in the AP group than in the NAP group (5.1% vs . 4.4% at 30 days; 18.6% vs . 14.7% at 12 months), but there were no statistically significant differences between the two groups. Cox regression analysis showed that maximum aortic diameter, PAU diameter ≥ 10.5 mm, and PAU depth ≥ 7.5 mm were associated with major adverse events. Conclusion The present study indicated that AP therapy may be safe for patients with acute PAUs who underwent TEVAR. Maximum aortic diameter, PAU diameter ≥ 10.5 mm, and PAU depth ≥ 7.5 mm were associated with major adverse events.