Multilayer stents in endovascular treatment of aortic dissection – safety, feasability and collateral permeability”

Victor Costache, Tania Melnic , Maged Mokbel, Crina Solomon, Andreea Costache, Anca Chitic, Constantin Condac

ABSTRACT

Background 
Despite recent progresses in cardiovascular medicine, a well established management of aortic dissection is still missed. Multilayer, flow-diverting stents represent a relatively new endovascular concept, targeting aortic reconstruction, rather than diseased region’s exclusion.

Methods Prospective, observational, single-centre study. Primary endpoint was early ischaemic events. Secondary endpoints included procedural success, procedural mortality and collaterals’ permeability evaluated by computational fluid dynamics (CFD). 20 patients with aortic dissection, including both type-B (N=13) and residual type-B after type-A correction (N=7) were included. All patients underwent multilayer stent implantation and had descending aorta fully coated. Imagistic studies and CFD analysis were performed pre- and post-intervention, then repeated at 3 months’ interval.

Results No early ischaemic events were documented. Procedural success was obtained in all patients. Neither late branch occlusion, nor procedural-related mortality was reported (maximum of 36 months). CFD analysis confirmed flow lamination in collinear branches, false lumen reduction (22.34±4.16%) and true lumen increase (14.31±3.28%). Over-all mortality was 10% (2 patients, gastrointestinal bleeding and cardiac tamponade after 12 and 36 months, respectively)

Conclusions Multilayer stents represent a safe therapeutic option in aortic dissections. Our experience suggests high success rate, low complications and reduced mortality. Further studies are urged to confirm their suggested role in complex

martie 29th, 2019|Publicatii|