Early Results Of A Newly-designed Dense Mesh Stent For Residual Dissection After Proximal Repair Of The Acute Aortic Dissection
Jia Hu1, Jian Zuo2, Zhen Li3, Chen Lu1, Peng Yang1, Zhong Wu1, Wei Meng1, Ying-Qiang Guo1
1West China Hospital, Sichuan University, Chengdu, China, 2Xijing Hospital, The Fourth Military Medical University, Xi'an, China, 3The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
Background: Negative remodeling of distal aorta due to residual dissection significantly impacts long-term outcomes of dissection patients after proximal open/endovascular repair of acute aortic dissection. Branched/fenestrated aortic stents are technically demanding and the results of first generation of multilayer flow modulator for tackling this clinical scenario is less satisfactory. This study was designed to evaluate early results of a newly-designed dense mesh stent (DMS) for residual dissection after proximal open/endovascular repair of acute type A or type B aortic dissection. Methods: Patients with non-chronic residual dissection involving visceral branches after proximal repair of aortic dissection were prospectively enrolled in three centers (Chictr.org.cn ChiCTR1900023638). Eligible patients were randomly assigned (1:1) to DMS group and control group. The primary endpoint was distal aortic remodeling, aortic-related events and patency of visceral branches at 1 year. Results: Totally 112 patients were enrolled, and baseline characteristics of 56 patients in both MFM and control groups were comparable. Mean follow-up period was 6.46±3.02 months, ranging from 1 to 12 months. One patient in the DMS group died from stroke 3 months after surgery. No aortic-related adverse events were observed in both groups, and all visceral arterial branches were patent in the DMS group. Favorable distal aortic remodeling in terms of increased area of true lumen (50.91±45.44 vs. 14.88±67.65 mm2 at the level of renal artery, 70.58±65.88 vs. 24.24±142.22 mm2 at the level of bifurcation of common iliac arteries, p<0.05) and decreased area of false lumen (-53.63±104.96 vs. 10.05±100.99 mm2 and -43.66±99.13 vs. 18.67±101.74 mm2, p<0.05) were observed in the DMS group compared to those parameters in the control group. Conclusions: This newly-designed DMS for endovascular repair of residual dissection is safe and effective in terms of 6-month mortality and morbidity, favorable distal aortic remodeling and patency of visceral branches.
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