Positive Remodeling of the Aorta Using Bare Metal Stent in Acute Type B Aortic Dissection

Objectives: Nowadays, thoracic endovascular aortic repair (TEVAR) has become a standard procedure to treat acute complicated type B aortic dissection (TBAD). This study sought to demonstrate the therapeutic effect of PETTICOAT (Proximal ExTension to Induce Complete ATtachment) concept on aortic remodeling in patients with acute complicated TBAD.

Methods: Since the introduction of the PETTICOAT technique to treat TBAD at our institution in 2009, 340 patients underwent a TEVAR procedure because of malperfusion or symptomatic TBAD. Out of 340, 63 patients underwent a bare metal stent implantation (EXL, Jotec, Germany) distal to the covered endograft (PETTICOAT) to expand compromised true lumen additionally to the standard TEVAR procedure. Aortic remodeling and dimensions of false and true luminas were analyzed based on computed tomography scans at discharge and up to 8 years postoperatively.

Results: The median age was 54 years (interquartile range [IQR]: 49–62 years) and 72% of patients were male. During the TEVAR procedure, stenting of visceral artery (SMA 4, coeliac trunc 2) or renal artery (10) was necessary in 15 patients. In study cohort, 30-day mortality was 3% (two patients). Three patients underwent replacement of thoracoabdominal aorta 8, 12 months, and 4 years after TEVAR. In one patient, proximal extension of the endograft was necessary because of aortic arch aneurysm 8 months after initial TEVAR procedure. In all other patients, a positive remodeling with significant expansion of true lumen and increase of the true lumen ratio was demonstrated in stented segment of the aorta during follow-up. Complete remodeling without any signs of persisting dissection was seen in 20 (32%) patients.

Conclusion: In addition to thoracic endograft, the use of a bare metal stent in thoracoabdominal aorta leads to positive remodeling of the aorta in patients with acute TBAD.