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Lu C, Wang H, Yang P, Liu Y, Zhang Y, Xu Z, Xie Y, Hu J. Early Results of the Newly-Designed Flowdynamics Dense Mesh Stent for Residual Dissection After Proximal Repair of Stanford Type A or Type B Aortic Dissection: A Preliminary Single-Center Report From a Multicenter, Prospective, and Randomized Study. J Endovasc Ther 2024; 31:984-994. [PMID: 36978288 DOI: 10.1177/15266028231163057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Negative remodeling of the distal aorta due to residual dissection significantly impacts the long-term outcomes of dissection patients after proximal repair of acute aortic dissection. Branched/fenestrated aortic stents are technically demanding, and studies of the first generation of multilayer flow modulators for tackling this clinical scenario are few and limited. The single-center results from a multicenter, prospective, and randomized controlled study aimed to verify the safety and effectiveness of a newly-designed flowdynamics dense mesh stent for treating residual dissection after proximal repair. METHODS Patients with nonchronic residual dissection involving visceral branches were prospectively enrolled in 3 centers (ChiCTR1900023638). Eligible patients were randomly assigned to the flowdynamics dense mesh stent (FDMS) group and control group. Follow-up visits were arranged at 1, 3, 6, and 12 months after recruitment. The primary endpoints were all-cause and aortic-related mortality. The secondary endpoints included visceral branch occlusion, reintervention, and severe adverse events. Morphological changes were analyzed to exhibit the therapeutic effect. Our center participated in the multicenter prospective randomized controlled trial, and the preliminary single-center experience was reported. RESULTS Thirty-six patients were enrolled in our center, and the baseline characteristics of the 2 groups were comparable. Thirty-four patients completed the 12 month follow-up. Freedom from all-cause and aortic-related death were 94.4% and 100%. All visceral branches remained patent in the FDMS group. Increased area of the true lumen (1.03±0.38 vs 0.48±0.63 cm2 at the plane below renal arteries, p=0.006; 1.27±0.80 vs 0.32±0.50 cm2 at the plane 5 cm below renal arteries, p<0.001) and decreased area of the false lumen at the plane below renal arteries (-1.03±0.84 vs -0.15±1.21 cm2, p=0.023) were observed in the FDMS group compared with those parameters in the control group. The FDMS group showed a significant increase in true lumen volume (p<0.001) and a significant decrease in false lumen volume (p=0.018). CONCLUSIONS This newly-designed FDMS for endovascular repair of residual dissection after the proximal repair is safe and effective at 12 months. CLINICAL IMPACT One-year results of the randomized controlled clinical trial indicated the short-term safety and promising effect of FDMS on treating non-chronic residual dissection after proximal repair. At the 12th-month follow-up, the true lumen expanded, the false lumen shrunk and all visceral arteries kept patent. As far as I'm concerned, this is the first randomized controlled study concerning utilizing multilayer flow mesh stent treating aortic dissection. Despite a preliminary single-center report, our results are supposed to provide high-quality evidence to guide clinical practice and fill the gap in the application of FDMS.
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Affiliation(s)
- Chen Lu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Haiyue Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Peng Yang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yu Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhenyuan Xu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yi Xie
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Department of Cardiothoracic Surgery, Guang'an Hospital, West China Hospital, Sichuan University, Guang'an, People's Republic of China
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Lu C, Duan W, Li Z, Wang C, Yang P, Liu Y, Zuo J, Hu J. One-year results of the Flowdynamics Dense Mesh Stent for residual dissection after proximal repair of stanford type A or type B aortic dissection: a multicenter, prospective, and randomized study. Int J Surg 2024; 110:4151-4160. [PMID: 38597396 PMCID: PMC11254268 DOI: 10.1097/js9.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/23/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Negative remodeling of the distal aorta following proximal repair for acute aortic dissection has garnered growing attention. This clinical scenario has spurred the development of techniques and devices. A multicenter, prospective, and randomized controlled study was conducted with the aim of confirming the safety and effectiveness of a newly-designed flowdynamics dense mesh stent for the treatment of residual dissection after proximal repair. METHODS Patients with nonchronic residual dissection affecting visceral branches were prospectively enrolled at three centers and randomly allocated to either the FDMS group or the control group. Primary endpoints encompassed all-cause and aortic-related mortality, while the patency of branch arteries is indeed a key focal metric. Morphological changes (diameter, area, and volume) were analyzed to demonstrate the therapeutic effect. RESULTS One hundred twelve patients were recruited in the clinical trial, and 103 patients completed the 12-month follow-up. The rate of freedom from all-cause and aortic-related death in the FDMS group was 94.64 and 100%, respectively. All visceral branches remained patent. The FDMS group exhibited a substantial expansion in TL and a notable shrinkage in FL at the planes below renal arteries (ΔArea TL : FDMS vs. Control, 0.74±0.46 vs. 0.34±0.66 cm 2 , P <0.001; ΔArea FL : FDMS vs. Control, -0.72±1.26 vs. -0.12±0.86 cm, P =0.01) and 5 cm below renal arteries (ΔArea TL : FDMS vs. Control, 1.06±0.75 vs. 0.16±0.63 cm 2 , P <0.001; ΔArea FL : FDMS vs. Control, -0.53±1.43 vs. -0.25±1.00 cm, P =0.27). Meanwhile, the FDMS group demonstrated an increase of 22.55±11.14 cm 3 in TL ( P <0.001) and a corresponding reduction of 21.94±11.77 cm 3 in FL ( P =0.08). CONCLUSIONS This newly-designed FDMS for endovascular repair of residual dissection following the proximal repair is demonstrated to be safe and effective at 12 months.
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Affiliation(s)
- Chen Lu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
| | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi Province
| | - Zhen Li
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Chenhao Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
| | - Peng Yang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
| | - Yu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
| | - Jian Zuo
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi Province
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan
- Department of Cardiothoracic Surgery, West China Guang'an Hospital, Sichuan University, Guang’an, Sichuan Province
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Mayer C, Pepe A, Hossain S, Karner B, Arnreiter M, Kleesiek J, Schmid J, Janisch M, Hannes D, Fuchsjäger M, Zimpfer D, Egger J, Mächler H. Type B Aortic Dissection CTA Collection with True and False Lumen Expert Annotations for the Development of AI-based Algorithms. Sci Data 2024; 11:596. [PMID: 38844767 PMCID: PMC11156948 DOI: 10.1038/s41597-024-03284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 04/22/2024] [Indexed: 06/09/2024] Open
Abstract
Aortic dissections (ADs) are serious conditions of the main artery of the human body, where a tear in the inner layer of the aortic wall leads to the formation of a new blood flow channel, named false lumen. ADs affecting the aorta distally to the left subclavian artery are classified as a Stanford type B aortic dissection (type B AD). This is linked to substantial morbidity and mortality, however, the course of the disease for the individual case is often unpredictable. Computed tomography angiography (CTA) is the gold standard for the diagnosis of type B AD. To advance the tools available for the analysis of CTA scans, we provide a CTA collection of 40 type B AD cases from clinical routine with corresponding expert segmentations of the true and false lumina. Segmented CTA scans might aid clinicians in decision making, especially if it is possible to fully automate the process. Therefore, the data collection is meant to be used to develop, train and test algorithms.
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Affiliation(s)
- Christian Mayer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Antonio Pepe
- Institute of Computer Graphics and Vision (ICG), Graz University of Technology, Inffeldgasse 16/II, 8010, Graz, Austria
| | - Sophie Hossain
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Barbara Karner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Melanie Arnreiter
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Jens Kleesiek
- Institute for Artificial Intelligence in Medicine (IKIM), AI-guided Therapies (AIT), Essen University Hospital (AöR), Girardetstraße 2, 45131, Essen, Germany
| | - Johannes Schmid
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Michael Janisch
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Deutschmann Hannes
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Jan Egger
- Institute of Computer Graphics and Vision (ICG), Graz University of Technology, Inffeldgasse 16/II, 8010, Graz, Austria.
- Institute for Artificial Intelligence in Medicine (IKIM), AI-guided Therapies (AIT), Essen University Hospital (AöR), Girardetstraße 2, 45131, Essen, Germany.
| | - Heinrich Mächler
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
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Hagedorn MN, Meisenbacher K, Skrypnik D, Bischoff MS, Böckler D. Standing the test of time: total aortic remodeling 13 years after TEVAR for acute type B aortic dissection. Indian J Thorac Cardiovasc Surg 2024; 40:86-90. [PMID: 38125333 PMCID: PMC10728030 DOI: 10.1007/s12055-023-01586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 12/23/2023] Open
Abstract
Long-term outcome after thoracic endovascular aortic repair (TEVAR) of acute type B aortic dissection (aTBAD) is still underreported in current literature. This case report shows persistence of aortic remodeling without secondary complication or need of reintervention 13 years after TEVAR. A 45-year-old woman was referred to the emergency room with aTBAD. Due to early diameter progression in combination with therapy-refractory pain and uncontrolled hypertension, TEVAR was performed. Hereafter, the patient showed complete remodeling of the descending thoracic aorta without persistent false lumen perfusion in this segment and with stable true and false lumen diameter in the untreated abdominal segment for a 13-year period. No aortic-related reintervention was needed. With contemporary devices and adapted therapy, TEVAR seems able to treat complex thoracic disease. Long-term follow-up (FU) is mandatory to monitor the efficacy and durability of endovascular treatment in aortic disease.
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Affiliation(s)
- Matthias Niklas Hagedorn
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Denis Skrypnik
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Moritz Sebastian Bischoff
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
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