Key result
High IVUS intimal flap mobility linked to ~79% greater true lumen expansion and fewer re-interventions.
Why the study?
TEVAR in chronic aortic dissection remains controversial, and the impact of intimal flap mobility on aortic remodelling after TEVAR was unknown.
Does high intimal flap mobility assessed by IVUS predict better aortic remodelling in patients with chronic Type B aortic dissection undergoing TEVAR?
Cohort (n=52)
No
Does high intimal flap mobility assessed by IVUS predict better aortic remodelling in patients with chronic Type B aortic dissection undergoing TEVAR?
Absolute Event Rate: 5.9% vs 3.3%
p-value: p=0.036
High intimal flap mobility assessed by IVUS during TEVAR for chronic Type B aortic dissection is associated with improved aortic remodelling and lower re-intervention rates.
May support IVUS flap mobility for risk stratification in chronic Type B TEVAR; leaves open prospective validation before guiding therapy.
Thoracic endovascular aortic repair (TEVAR) in chronic aortic dissection remains controversial. We analysed whether a high intimal flap mobility (IFM) of the dissection membrane has an impact on aortic remodelling after TEVAR in chronic Type B aortic dissection. Patients undergoing TEVAR with intravascular ultrasound (IVUS) were analysed and IFM was calculated. High IFM was defined as maximum flap amplitude >3 mm. For determining aortic remodelling, the degree of true lumen (TL) expansion was analysed in the last available follow-up CT. Fifty-two patients (63.6 ± 15.4 years) with a mean follow-up of 26.6 ± 20.7 months were analysed. The mobile flap group (n = 29) showed higher absolute TL expansion at the distal stent-graft (5.9 ± 3.1 vs. 3.3 ± 5.4 mm; p = 0.036) and a higher increase in TL diameter (18 ± 10 vs. 9 ± 15%; p = 0.017) compared to the non-mobile group (n = 23). Basic TEVAR-related outcome characteristics were comparable, but the mobile intimal flap group showed a lower re-intervention rate (3 vs. 8pts.; p = 0.032) in chronic dissections. High IFM in chronic Type B aortic dissection is linked to improved aortic remodelling and is associated with a lower re-intervention rate over time. IVUS assessment of IFM in chronic Type B aortic dissection might be helpful in identifying patients with better remodelling after TEVAR.
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Lortz et al. (2019) conducted a cohort in Chronic Type B aortic dissection (n=52). High intimal flap mobility (maximum flap amplitude >3 mm) vs. Low intimal flap mobility (maximum flap amplitude ≤3 mm) was evaluated on Absolute true lumen (TL) expansion at the distal stent-graft (p=0.036). High intimal flap mobility (>3 mm) assessed by IVUS in chronic Type B aortic dissection was associated with significantly greater absolute true lumen expansion at the distal stent-graft (5.9 vs 3.3 mm) and a lower re-intervention rate.
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