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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Comparative Efficacy of Integrated Stent-Graft versus Conventional Covered Stent-Graft Alone in Type B Aortic
Jieyu Cao1, Zhengwen Lei1, Keke Xu2
1Department of Cardiothoracic Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, 421001 Hengyang, Hunan, China.
Background:
To compare the early efficacy of an integrated stent-graft (16-cm covered stent combined with a 6-cm distal bare stent) versus a conventional covered stent-graft alone in patients with acute type B aortic dissection (TBAD), with a focus on aortic remodeling and branch artery perfusion.
Methods:
In this single-center retrospective cohort study, 102 patients were included (integrated stent-graft: n = 34; conventional stent-graft: n = 68). Aortic remodeling was assessed using the true lumen area ratio at five predefined anatomical planes. Branch artery perfusion patterns and procedure-related complications were evaluated preoperatively and at 3-month follow-up.
Results:
At 3 months, the integrated stent-graft group demonstrated significantly higher true lumen area ratios at the left subclavian artery plane 0.60 (0.41, 0.63) vs. 0.41 (0.25, 0.54), p = 0.002; pulmonary artery plane 0.65 (0.54, 0.71) vs. 0.44 (0.38, 0.53), p < 0.001; and diaphragmatic plane 0.61 (0.50, 0.76) vs. 0.44 (0.37, 0.51), p < 0.001. No significant differences were observed at the renal or iliac planes. Regarding branch perfusion, a significant overall difference in postoperative perfusion pattern distribution was observed for the celiac trunk (p = 0.027) and left renal artery (p = 0.017). No differences were detected in other branch arteries. The incidence of postoperative new entry tears was lower in the integrated stent-graft group (23.5% vs. 41.2%), although this difference did not reach statistical significance (p = 0.079).
Conclusions:
In this exploratory retrospective study with short-term (3-month) follow-up, the integrated stent-graft system was associated with improved early true lumen remodeling in the proximal and mid-aortic segments and differences in branch artery perfusion patterns compared with a conventional covered stent-graft alone. A trend toward fewer new entry tears was observed, but given the limited follow-up and sample size, these findings should be considered preliminary. Confirmation in larger prospective studies with long-term follow-up is warranted to determine whether these early imaging changes translate into durable clinical benefit.
