Volumetric analysis in primary and residual type B aortic dissection treated with STABILISE technique can predict aortic reintervention.

BACKGROUND: The aim of this study was to investigate the mid-term results of Stented-Assisted Balloon-Induced Intimal Disruption and Relamination (STABILISE) in patients with aortic dissection with the implememntation of volumetric analysis.

METHODS: This was a single centre retrospective analysis of prospectively collected data. From May 2017 to September 2022, 42 patients underwent STABILISE for acute complicated or subacute high-risk aortic dissection. STABILISE was completed with DEEVAR in 24 patients. A CT scan was performed at baseline, before hospital discharge and at 1, 3 and 5 years. Perfused total aortic, true lumen and false lumen volumes were assessed for thoracic, visceral and aorto-iliac segment. The ratio between false lumen and total volume was named perfusion dissection index (PDI). Complete remodeling was defined as PDI = 0, and positive remodeling as PDI ≤0.1.

RESULTS: Technical success was 97.6%. No 30-day deaths, spinal cord injuries or retrograde dissections were observed. Mean follow-up was 44 ± 19.4 months. Thoracic diameter was lower at last available CT scan (36.7 vs 33.0 mm, p=.01). Aortic growth >5 mm was observed in 9.5% of the patients. Thoracic and visceral aortic complete remodeling were 92.8% and 83.3%, respectively, with no difference between acute and subacute group. DEEVAR significantly increased complete remodeling in the aorto-iliac segment, compared to STABILISE alone (69.6% vs 21.4%, p<.001). Freedom from vascular re-interventions at 3 years was 83.1% (95% CI 71.5-96.6). Total PDI ≤0.1 at first postoperative control was a predictor of vascular re-interventions (p<.0001).

CONCLUSION: STABILISE is a safe and feasible technique associated with high mid-term rates of complete remodeling in the thoracic and visceral aorta. Volumetric analysis allows the quantification of aortic remodeling and represents a predictor of aortic re-interventions.