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Volumetric Evaluation Of Aortic Remodeling Following Type B Aortic Dissection (tbad) Repair Using Petticoat And Stabilise Technique
Gabriel Blake Rodriguez, PhD, MSPH, Lan Le, MD, Joshua Goldberg, MD, Suguru Ohira, MD, PhD, Igor Laskowski, MD, PhD.
Westchester Medical Center, Valhalla, NY, USA.
OBJECTIVE: We previously showed that stent-assisted balloon-induced intimal disruption and relamination (STABILISE) is superior to the provisional extension to induce complete attachment (PETTICOAT) approach in TBAD patients using 2D imaging evaluation in the early follow-up. The current study is aimed to evaluate aortic remodeling between the techniques using 3D volumetric analysis.
METHOD: Single-center retrospective analysis of pre-and post-intervention volumetric aortic measurements was obtained using the 3D Slicer (version 5.6.2), a free open-source software, of ten consecutive patients who underwent STABILISE and PETTICOAT intervention for acute complicated TBAD From June 2019 to November 2022. Thoracic and abdominal aortic Ishimura Zones 3 to 5 and 6-9 were assessed. The Wilcoxon Test was used for true and false lumen (TL, FL) volume evaluation between the two techniques and a paired samples t-test within each technique. Normality assumptions analyses were confirmed.
RESULTS: The PETTICOAT patients were 57 years old (median, IQR 49-60), 80% male; the STABILISE group was 100% male and 62 years of age (median, IQR 60-63). Time from presentation to surgery was 7 days (median, IQR 2-11) and 2 days (IQR 1-15) respectively. Follow-up was 29 days (IQR 14-52) and 22 days (IQR 5-22) for PETTICOAT and STABILISE, respectively. No 30-day deaths, aortic rupture, reinterventions, spinal cord ischemia, or renal failure were observed. When comparing techniques, none of the pre-intervention TL or FL volumes in either zone showed statistically significant differences. TL was significantly larger in STABILISE group by 63.57ml in zones 3 to 5 in post-intervention compared to PETTITCOAT (p = 0.032). Although not statistically significant, there was a trend towards a smaller FL in the STABILISE group post-intervention compared to PETTICOAT for the same zones (-69.73ml, p = 0.056). In zones 6 to 9, no significant post-intervention differences between the techniques were observed.Within STABILIZE technique, we observed a significant mean increase in TL post-intervention of 133.8ml (p < 0.001) and significant mean reductions in FL post-intervention: -78.7ml (p < 0.001) in zones 3 to 5.
CONCLUSION: 3D volume measurements can be used to evaluate aortic remodeling after endovascular repair of TBAD. In this patient cohort STABILISE technique achieved significantly better positive aortic remodeling compared to PETTICOAT expressed by TL increase and FL decrease. Future research should investigate trends in mid- and long-term follow-up.
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