O-150 - WHAT DO WE KNOW ABOUT THE DIFFERENTIAL PERFORMANCE OF STABILISE AND DEEVAR PETTICOAT IN AORTIC REMODELING OF ACUTE, SUBACUTE, AND CHRONIC DISSECTION? HOW DOES THIS MAY AFFECT OUR DECISION-MAKING?

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Leo E. (A. Manzoni Hospital ~ Lecco ~ Italy) , Molinari A. (A. Manzoni Hospital ~ Lecco ~ Italy) , Ferraresi M. (A. Manzoni Hospital ~ Lecco ~ Italy) , Ferrari S. (A. Manzoni Hospital ~ Lecco ~ Italy) , Sommaruga S. (A. Manzoni Hospital ~ Lecco ~ Italy) , Segreti S. (A. Manzoni Hospital ~ Lecco ~ Italy) , Rossi G. (A. Manzoni Hospital ~ Lecco ~ Italy)
Introduction:
Aortic dissection is an evolving pathology and not all cases have the same natural history. Multiple studies have shown that the aorta remodels far better in the early phase of dissection than in its chronic phase.1 However, the exact cutoff is not yet clearly proven. In acute/subacute aortic dissections, the STent-Assisted Balloon-Induced intimaL dISruption and rElamination (STABILISE) procedure proved to be safe and reproducible2 and we previously reported encouraging results with the Distal Extended EndoVascular Aortic Repair (DEEVAR) Petticoat.3 The chronicity of dissection from the onset of symptoms may influence the efficacy of endovascular treatment as well as the risk of morbidity/mortality.1 The aim of this study was to investigate how aortic wall changes over time in various stages of dissection may affect the benefit of these endovascular therapies.
Methods:
A single-center prospectively maintained database enrolled all patients treated for acute, subacute, and chronic aortic dissection with the STABILISE technique and the DEEVAR Petticoat procedure in our division. Patients were monitored before hospital discharge and then at 6 and 12 months and annually thereafter with clinical and imaging studies. Outcome analyses included survival, rupture, spinal cord ischemia, endoleak, morbidity (cardiac, renal, or pulmonary), reinterventions, false lumen remodeling, and aneurysm growth.
Results:
From January 2015 to February 2022, 55 patients were admitted to our institution for endovascular treatment of aortic dissection. Among them, 13 patients were treated for acute, complicated DeBakey type III aortic dissection, 25 patients for symptomatic or "high risk" subacute residual thoracoabdominal aortic dissection after emergent ascending aorta repair in acute DeBakey type I dissection, and 17 patients for chronic DeBakey type III aortic dissection (symptomatic in 4 cases). All patients underwent a STABILISE procedure, while 28 patients were treated with an extended endovascular treatment (DEEVAR). Technical success was obtained in all patients. There was no death, stroke, paraplegia/paraparesis, or acute renal failure within 30 days post-operatively. Follow-up was complete in all patients and ranged from 1 month to 61 months (median, 31 months). During follow-up, we observed 2 deaths (3.6%), in one case aortic-related. The 1-year cumulative freedom from reintervention was 83.7% (88.3% in acute/subacute dissections and 72.9% in chronic cases, p = n.s.). Complete aortic false lumen remodeling was observed in 23 patients (41.8%), 5 acute dissections, 16 subacute, and 2 chronic cases (p < 0.05). The 3-years cumulative incidence of complete aortic remodeling was 54.6%, 62.8% in acute/subacute cases, and 25% in chronic patients (p <0.05).
Conclusion:
According to the literature, the present findings suggest that the subacute phase is the safer and effective period for STABILISE and DEEVAR Petticoat in patients with aortic dissection. Although the timing is patient-specific, it seems to range from 2 to 15 weeks. In our practice, decision-making is based on clinical presentation and imaging features but these data underscore the value of interval surveillance imaging to identify impactful aortic changes, especially in patients with residual thoracoabdominal aortic dissection.
References:
1. Nienaber CA, Kische S, Rousseau H et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6:407-16. 2. Faure EM, El Batti S, Rjeili MA, Julia P, Alsac JM. Mid-term outcomes of stent assisted balloon induced intimal disruption and relamination in aortic dissection repair (STABILISE) in acute type B aortic dissection. Eur J Vasc Endovasc Surg 2018;56:209-15. 3. Leo E, Molinari ACL, Ferraresi M, Rossi G. Short term outcomes of Distal Extended EndoVascular Aortic Repair (DEEVAR) Petticoat in acute and subacute complicated type B aortic dissection. Eur J Vasc Endovasc Surg 2021;62:569-74.