(IP051) Long term outcomes of TEVAR with Dissection Stents for complicated Type B aortic Dissection

Objectives: Dissection stents are large caliber bare metal stents used in treatment of acute Type B aortic dissection, to reduce false lumen size and induce false lumen thrombosis (FLT) while preserving flow into critical visceral arteries. In short term these stents have demonstrated efficacy of repair however, their long term outcomes have not been investigated. This report examines the efficacy of dissection stents in terms of positive aortic re-modelling, re-intervention and mortality.

Methods: This retrospective review included all patients who required TEVAR following type B aortic dissection from August 2008 to December 2023 . Patients who had the TEVAR were compared with those who had placement of an additional dissection stent across the Zones 6-9. Patients who expired on index hospitalization or had no follow-up CTs were not included. Freedom from death and reintervention , False lumen pressurization, aneurysmal degeneration were estimated for both cohorts. Categorical variables were compared using chi-square and Fisher’s exact analysis. Quantitative variables were compared using students t-test.

Results: A total of 69 patients (22 women, 47 men) with mean age of 60.4 years, underwent TEVAR for complicated TBAD. Ten patients who had died on index hospitalization and five that did not have post-operative CT available were excluded. Of the 54 included patients, 47 had acute dissection (87%) and 7 patients had subacute dissection(13%). Twenty-one patients had dissection stents placed (36.67%). Baseline demographics were similar between the dissection stent and non-dissection stent groups. Five patients (9.2%) died in long term follow-up. During the mean follow up of 3.9 +/- 3.3 years, there was no difference between the patients who had TEVAR with those who had an additional dissection stent in terms of long term mortality rates (log rank=0.88; figure 1) or rates of re-intervention (log rank=0.70; figure 2) by Kaplan Meier analysis. Patients who had dissection stents placed had lower rates of FLT of the thoracic aorta (57.2% vs 75.7% vs p=0.15) and similar rates of FLT of the abdominal aorta (9.5% vs 15.3%; p=0.55) compared to patients without dissection stents.

Conclusions: Long term outcomes following TEVAR with additional dissection stents have similar rates of re-modelling, re-intervention and mortality in the long term and provide no additional benefit in the management of complicated TBAD.