What is the clinical evidence from this study?

Study design: Cohort. Population: Complicated aortic dissection (n=16). Intervention: STABILISE technique. Primary outcome: Re-intervention requiring additional stenting.

What does this research mean for the field?

The STABILISE technique for complicated aortic dissection is safe, achieving technical success with no procedural mortality, a 13% re-intervention rate, and stable mid-term aortic remodelling. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

January 27, 2022Open Access

STABILISE; treatment of aortic dissection, a single Centre experience

GMGoran MitreskiThe University of Melbourne DFDamian FlandersBarwon Health JMJulian MaingardSociety of Interventional Radiology

Key Result

The STABILISE technique for complicated aortic dissection achieved technical success with no procedural mortality and a 13% re-intervention rate, demonstrating stable mid-term aortic remodelling.

Study Design

Type

Cohort (n=16)

Multicenter

Structured PICO

Does the STABILISE technique improve aortic remodelling and clinical outcomes in patients with complicated aortic dissection?

Population

16 patients with complicated aortic dissection (14 acute, 2 chronic), median age 61 years, 69% male. Indications included visceral malperfusion, aortofemoral malperfusion, rupture, false lumen growth >5 mm, max aortic size >40 mm, refractory pain, and refractory hypertension.

Intervention

STABILISE technique (stent assisted balloon induced intimal disruption and relamination) using the Zenith Dissection Endovascular System (proximal covered stent and distal bare stents) followed by balloon dilatation to obliterate the false lumen.

Outcome

Aortic remodelling (reduction in false lumen size and stability of total luminal dimensions) and patient outcomes (procedural mortality, re-intervention rate) at mid-term follow-up.surrogate

The STABILISE technique appears to be a safe and effective endovascular approach for complicated aortic dissection, promoting stable mid-term aortic remodelling and false lumen obliteration.

Limitations

Small sample size
Single centre retrospective experience

Abstract

PURPOSE: To outline the process of the STABILISE technique and its use; reporting patient outcomes and midterm follow up for complicated aortic dissection. MATERIALS AND METHODS: Single centre retrospective analysis from January 2011 to January 2021 using the STABILISE technique which utilises balloon assistance to facilitate intimal disruption and promote aortic relamination. RESULTS: Sixteen patients underwent endovascular aortic repair with the STABILISE technique for aortic dissection over the study period. Fourteen patients (14/16; 88%) had acute dissection. Two of 16 (12%) were chronic. The median age of the patient cohort was 61 years (range 32-80 years) and consisted of a male majority (n = 11; 69%). The median time from diagnosis to intervention was 5 days (1-115 days; IQR 1-17.3). More than half (56%) had surgical repair of a acute type A aortic dissection prior to radiological intervention. The procedure was technically successful with no procedural mortality. Two patients were lost to follow up and two died in the post-operative period. Twelve patients had ongoing follow up with an average number of 2.9 ± 1.6 scans performed. Follow up was available in thirteen patients (81%) with a median follow up period of 1097 days (IQR 707-1657). The rate of re-intervention (n = 2/16; 13%) requiring additional stenting was in line with published re-intervention data (15%). Follow up showed a reduction in false lumen size following treatment with total luminal dimensions remaining stable over the follow-up period. CONCLUSION: The STABILISE technique as a procedure for complicated aortic dissection, either acute or chronic, appears safe with stable mid-term aortic remodelling and patient outcomes. LEVEL OF EVIDENCE: Level 3, Retrospective cohort study.

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