Self-expandable versus balloon-expandable bridging stents in off-the-shelf inner branch repair: Midterm results from...

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aortic Aneurysm Treatment

Background:

• The E-nside off-the-shelf inner-branch endograft is used for complex aortic aneurysm repair.
• Bridging stents are crucial for maintaining target vessel patency within endografts.
• Comparing self-expandable (S-EXP) and balloon-expandable (B-EXP) bridging stents is important for optimizing outcomes.

Purpose of the Study:

• To compare the outcomes of S-EXP and B-EXP bridging stents used with the E-nside endograft.
• To evaluate target vessel instability (TVI) as a primary endpoint in complex aortic aneurysm repair.
• To identify predictors of TVI in patients undergoing endovascular repair with inner-branch endografts.

Main Methods:

• Analysis of patients from the ItaliaN Branched Registry of E-nside EnDograft (INBREED) registry (2021-2024).
• Comparison of S-EXP and B-EXP bridging stents based on clinical, anatomical, and procedural data.
• Primary endpoint: Target Vessel Instability (TVI), a composite of major adverse events. Secondary endpoints: technical success and reintervention rates.

Main Results:

• 148 patients and 581 target vessels (TVs) were analyzed; 72.8% used B-EXP and 27.2% used S-EXP stents.
• Overall technical success was high (99.5%).
• Crude TVI rate was lower with S-EXP (3.2%) vs. B-EXP (8.3%; p=.03), but not significant in multivariable analysis. Renal TVs (OR 1.87) and pre-existing stenosis (OR 1.93) were independent predictors of TVI.

Conclusions:

• Inner-branch endovascular repair with the E-nside endograft demonstrates high technical success and favorable mid-term outcomes.
• While S-EXP stents showed a lower crude TVI rate, this difference was not statistically significant after multivariable adjustment.
• Renal target vessels and pre-existing target vessel stenosis are identified as the primary predictors of instability.