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 SS3. Aortic Remodeling After Endovascular Treatment of Complicated Type B Aortic Dissection Using a Composite Device Design: A Report from the STABLE Trial

Joseph V. Lombardi1, Richard P. Cambria2, Christoph Nienaber3, Roberto Chiesa4, Omkee Teebken5, Anthony Lee6, Peter Mossop7, Stéphan Haulon8, Qing Zhou9, Feiyi Jia9
1Surgery, Cooper University Hospital, Camden, NJ; 2Massachusetts General Hospital, Boston, MA; 3University Hospital Rostock, Rostock, Germany; 4Hospital San Raffaele, Milano, Italy; 5Hanover Medical School, Hannover, Germany; 6Christine E Lynn Heart and Vascular Institute, Boca Raton, FL; 7St. Vincent's Hosptal, Melbourne, VIC, Australia; 8Chirurgie Vasculaire, Hospital Cardiologique, Chru de Lille, Lille, France; 9Med Institutel, West Lafayette, IN.

OBJECTIVES: We report aortic remodeling from the STABLE trial, a prospective, multicenter study evaluating safety and effectiveness of a pathology-specific endovascular system (proximal stent-graft and distal bare metal stent) for the treatment of complicated type B aortic dissection (cTBAD).
 
METHODS: All 86 enrolled patients (mean age 59 years; 73% male) were treated within 90 days of symptom onset (64% treated within 14 days). Aortic remodeling through 2 years was assessed in patients with available aortic size data (as of April 2012).
 
RESULTS: The 30-day mortality rate was 4.7% (4/86); patient survival was 88% at 1 year and 85% at 2 years. From baseline to 2 years (Figure 1), the true lumen diameter increased significantly in the descending thoracic aorta (DTA) and the more distal abdominal aorta (AA), with a concomitant decrease in false lumen diameter. Transaortic growth (>5mm) occurring at any time within 2 years was observed in the DTA in 21 patients and in the AA in 21 patients; a majority of these patients had acute dissection (17/21 for DTA, 20/21 for AA). Mortality, rupture, conversion and secondary intervention were not significantly different between patients with and without transaortic growth. A generalized linear model indicates that a shorter time from symptom onset to treatment predicts transaortic growth in both the DTA (p=0.03) and AA (p<0.001), and a higher SVS risk score for hypertension predicts growth in the AA (p=0.04).
 
CONCLUSIONS: Endovascular repair of cTBAD using a composite construct demonstrates favorable aortic remodeling. However, patients treated in the acute setting may be prone to aortic growth and require close observation. Follow-up through 5 years is ongoing.
 
AUTHOR DISCLOSURES: R. P. Cambria: Cook Medical, Research grants; R. Chiesa: Nothing to disclose; S. Haulon: Cook Medical, Consulting fees or other remuneration (payment); GE Healthcare, Consulting fees or other remuneration (payment); F. Jia: Med Institute, Employment (full or part-time); A. Lee: Cook Medical, Research grants; J. V. Lombardi: Cook Medical, Research grants; P. Mossop: Cook Medical, Consulting fees or other remuneration (payment); C. Nienaber: Medtronic, Consulting fees or other remuneration (payment); Boston Scientific, Consulting fees or other remuneration (payment); Cook Medical, Honorarium; Bolton, Honorarium; Medtronic, Honorarium; O. Teebken: Bolton, Research grants; Cook Medical, Research grants; Jotec, Research grants; Cook Medical, Honorarium; Gore, Honorarium; Medtronic, Honorarium; Q. Zhou: Med Institute, Employment (full or part-time).

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Posted April 2013

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