The Role of Multilayer Stents in the Treatment of Aortic Dissection: A Single-Center Experience Multilayer Flow Modulator Stents in Aortic Dissection

1.Melnic1,2 M.D, V.S.Costache1,2 MD PhD, C.Solomon1 M.D, A. Costache1,2 M.D,

Sandu Mihai-Alexandru1, Cristian Bucurenciu1, Sandu Anca-Maria1.

  1. Lucian Blaga University, Sibiu, România, NEXTcardio Project
  2. European Hospital Polisano, Sibiu

ABSTRACT

Background: Reported are up to 36 month outcomes of patients with type B aortic dissection managed by multilayer stents. We aim to present our single center experience and results with this technique in patients with complete up to three years clinical and imagistic follow-up after the treatment of aortic dissection using new generation of aortic multilayer stents.  Primary endpoint was freedom from rupture or dissection-related death at 18 months. Secondary endpoints were absence of major adverse events, absence of graft rupture or major side branches occlusion.

Methods: This study is a prospective single center analysis of patients with complex aortic dissection that underwent endovascular repair with this new generation MFM stents. All 15 patients (mean age 49 years, range from 27-73, 12 men) were treated between April 2014 and September 2017 in the Polisano European Hospital, Sibiu. The indications were type B aortic dissection for 11 patients and residual type B after type A surgical correction for 4 patients.

Morphologic computerized fluid dynamics (CFD) analysis was performed by using MIMICS software (Materialise, Belgium) that measured dissection remodeling by a reduction in longitudinal length of the dissected aorta, and changes of the transversal diameter of the true lumen and false lumen compared with the pre- and post-treatment. Flow CFD simulations of high resolution CT scans were performed at each follow up using ANSYS software (ANSYS, Inc. Southpointe USA).

Results: 15 patients with aortic dissection, underwent thoracic endovascular aortic repair (TEVAR) with a new generation multilayer aortic stents. Indications included: type B dissection (n=11), residual type B after type A surgical correction (n=3) and acute type B after surgical correction of a type A dissection requiring immediate intervention for a malperfusion syndrome (n=1).

There were no reported ruptures or aortic-related deaths. Initial procedural success was 100% with no branch occlusions during follow-up. All patients are alive with the longest follow up of 36 months and an average follow-up of 18 months.

Twelve-month freedom from neurologic events was 100%, and there were no incidences of end-organ ischemia, paraplegia or renal insult.

Morphologic CFD analysis was performed with MIMICS that confirmed dissection remodeling by a reduction in false lumen volume and diameter.

Conclusion: MFMS are a safe option in the treatment of complex aortic dissections, with low mortality and good procedural success.

 

octombrie 23rd, 2018|Publicatii|