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Dynamic Indicators That Impact the Outcomes of Thoracic Endovascular Aortic Repair in Complicated Type B Aortic
Shuo Zhao1, Hui Gu1, Baojin Chen1
1Department of Radiology, Shandong Provincial Hospital, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, China.
Insights
Dynamic variables from CT angiography can predict thoracic endovascular aortic repair (TEVAR) outcomes in complicated type B aortic dissection (cTBAD). Larger differences in true lumen area (D-TLA) indicate worse outcomes and aid in risk stratification.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Aortic Disease
Background:
- Complicated type B aortic dissection (cTBAD) poses significant risks.
- Thoracic endovascular aortic repair (TEVAR) is a common treatment for cTBAD.
- Predicting TEVAR outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate dynamic computed tomography angiography (CTA) variables for predicting TEVAR outcomes in cTBAD patients.
- To identify specific parameters that correlate with early and late adverse events after TEVAR.
Main Methods:
- Retrospective analysis of 79 cTBAD patients who underwent TEVAR.
- Calculation of relative true lumen area (r-TLA) throughout the cardiac cycle.
- Evaluation of intimal motion parameters, including difference between maximum and minimum r-TLA (D-TLA).
Main Results:
- Early mortality was 13.9% and early adverse events were 24.1%.
- Worse outcomes were observed in patients treated within 2 days of symptom onset.
- Increased D-TLA was independently associated with higher early mortality (AUC 0.849) and adverse events (AUC 0.742).
Conclusions:
- Larger D-TLA values correlate with poorer postoperative outcomes in cTBAD patients.
- D-TLA may serve as a critical parameter for future risk stratification after TEVAR.
- Dynamic CTA variables offer valuable insights into TEVAR success in cTBAD.
Purpose:
To investigate dynamic variables obtained from retrospective computed tomography angiography for ability to predict thoracic endovascular aortic repair (TEVAR) outcomes in patients with complicated type B aortic dissection (cTBAD).
Materials And Methods:
Seventy-nine patients with cTBAD who received TEVAR from March 2009 to June 2018 were retrospectively enrolled. Relative true lumen area (r-TLA) was computed at the level of tracheal bifurcation every 5% of all R-R intervals. Parameters that reflect the state of intimal motion were evaluated, including difference between maximum and minimum r-TLA (D-TLA) and true lumen collapse. The endpoints comprised early (≤ 30 days) and late (> 30 days) outcomes after intervention.
Results:
Overall early mortality rate was 13.9% (11/79), and early adverse events rate was 24.1% (19/79). Patients who received TEVAR within 2 days of symptom onset demonstrated the worst outcomes. A longer time of r-TLA < 25% in 1 cardiac cycle (P = .049) and larger D-TLA (P < .001) were correlated to an increased early death. In addition, D-TLA was an independent predictor of early mortality. Area under the curve of D-TLA was 0.849 (95% confidence interval 0.730-0.967) for predicting early mortality and 0.742 (95% CI 0.611-0.873) for predicting early adverse events. Survival and event-free survival rates during follow-up were decreased in the D-TLA > 21.5% group compared with the D-TLA ≤ 21.5% group (all P < .001).
Conclusions:
Larger D-TLA is correlated with worse postoperative outcomes and might be a crucial parameter for future risk stratification in patients with cTBAD.
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