胸部血管内大動脈修復術におけるステント延長のタイプB大動脈解離に対する長期予後

The long-term efficacy of stent extension in thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) has not been thoroughly evaluated.

This retrospective, multicenter study included TBAD patients undergoing TEVAR between 2014 and 2021. On the basis of distal descending aorta coverage, patients were stratified into Stent Extension (SE) and Non-Stent Extension (Non-SE) groups. Stent extension was defined as the intentional distal placement of an additional covered stent to lengthen the repair zone within the descending aorta. After 1:1 propensity score matching (PSM) to balance baseline and perioperative characteristics, long-term outcomes were compared. Multivariate regression analysis identified risk factors.

Among 511 enrolled patients with the median age was 56 (51, 63) years, 241 received stent extension, and the average follow-up time was 69.4 months. After PSM (131 pairs), the groups were comparable. The SE group showed significantly lower rates of aortic-related mortality(3.8% vs. 10.7%; P=0.032), negative aortic remodeling(13.7% vs. 23.7%; P=0.039), follow-up entry flow(8.4% vs. 18.3%; P=0.018), and reoperation(3.8% vs. 11.5%; P=0.020). Stent extension was a protective factor against entry flow(odds ratio[OR] 0.67, P=0.014) and negative remodeling(OR 0.73, P=0.002). Risk factors included smaller true lumen diameter and patent false lumen for entry flow and patent false lumen with multiple distal tears for negative remodeling. Entry flow independently predicted aortic-related mortality(OR 3.54, P<0.001) and reoperation(OR 5.63, P<0.001).

Stent extension during TEVAR for TBAD is associated with improved long-term outcomes, reducing complications and reinterventions. Prospective trials are warranted for validation.