What is the Optimal Proximal Landing Zone of the Stent Graft in Treatment of Aortic Type B Dissection?

Purpose Retrograde type A aortic dissection (RTAD) represents a serious complication of endovascular treatment for type B aortic dissection (TBAD). To avoid RTAD, it is recommended to land the proximal end of the stent graft in a non-dissected aortic segment. In this study, we investigated whether l...

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Bibliographic Details
Published in:Cardiovascular and interventional radiology 2024-08, Vol.47 (8), p.1037-1044
Main Authors: Cho, Tomoki, Uchida, Keiji, Yasuda, Shota, Izubuchi, Ryo, Kaneko, Shotaro, Minami, Tomoyuki, Saito, Aya
Format: Article
Language:English
Subjects:
Aorta
Aortic dissection
Arterial Interventions
Cardiology
Cardiovascular system
Clinical Investigation
Dissection
Imaging
Implants
Injuries
Medicine
Medicine & Public Health
Nuclear Medicine
Radiology
Ultrasound
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Summary:Purpose Retrograde type A aortic dissection (RTAD) represents a serious complication of endovascular treatment for type B aortic dissection (TBAD). To avoid RTAD, it is recommended to land the proximal end of the stent graft in a non-dissected aortic segment. In this study, we investigated whether landing in the dissection area increased the number of events at the proximal site. Methods We conducted a retrospective review of endovascular treatments for TBAD at a single institution between 2009 and 2022. Patients were divided into two groups: group A, with a proximal landing zone entirely within the dissected area, and group B, with the proximal extent of the seal zone in the non-dissected area. We evaluated the occurrence of proximal events, including RTAD, and examined long-term outcomes to assess the validity of landing in the dissection area. Results The study included eighty-nine patients who underwent endovascular treatment for TBAD. New intimal tears in the proximal landing site occurred in 3 cases (3.4%), with 1 case (2%) in group A and 2 cases (5.1%) in group B, showing no significant difference. Among the three cases, one (1.1%) in group B with zone 2 landing resulted in RTAD. At 60 months, the overall survival was 85%, and freedom from aorta-related mortality was 88%, with no significant difference between the groups. Conclusion Even if the proximal landing is in a dissected area, a treatment strategy performed in zone 3 without proximal landing in zone 2, seeking a non-dissected area, can still provide sufficient therapeutic effects. Level of Evidence 3 Retrospective single-center cohort analysis. Graphical Abstract
ISSN:0174-1551
1432-086X
1432-086X
DOI:10.1007/s00270-024-03791-0