Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug;30(4):510-519.
doi: 10.1177/15266028221086474. Epub 2022 Mar 30.

In Vivo Quantification of Cardiac-Pulsatility-Induced Motion Before and After Double-Branched Endovascular Aortic Arch Repair

Jaimy A Simmering  1   2 , Steven J G Leeuwerke  1 , Robbert Meerwaldt  1 , Clark J Zeebregts  3 , Cornelis H Slump  4 , Robert H Geelkerken  1   2
Affiliations

In Vivo Quantification of Cardiac-Pulsatility-Induced Motion Before and After Double-Branched Endovascular Aortic Arch Repair

Jaimy A Simmering et al. J Endovasc Ther. 2023 Aug.

Abstract

The Relay®Branch stent-graft (Terumo Aortic, Sunrise, FL, USA) offers a custom-made endovascular solution for complex aortic arch pathologies. In this technical note, a modified electrocardiography (ECG)-gated computed tomography (CT)-based algorithm was applied to quantify cardiac-pulsatility-induced changes of the aortic arch geometry and motion before and after double-branched endovascular repair (bTEVAR) of an aortic arch aneurysm. This software algorithm has the potential to provide novel and clinically relevant insights in the influence of bTEVAR on aortic anatomy, arterial compliance, and stent-graft dynamics.

Keywords: ECG-gated computed tomography; aorta dynamics; aortic arch aneurysm; branched endovascular aorta repair; stent-graft dynamics; thoracic endovascular aortic repair.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: R.H.G., C.J.Z., and R.M. are consultants for Terumo Aortic.

Figures

Figure 1.
Figure 1.
Three-dimensional (3D) rendering of part of the preoperative computed tomography (CT) volume, showing the saccular aneurysm in the aortic arch (red arrow).
Figure 2.
Figure 2.
The selected points for motion amplitude calculations for the preoperative (A) and postoperative (B) electrocardiogram (ECG)-gated computed tomography (CT) scans. Points 1 and 2: ventral/dorsal ascending aorta and first stent ring, respectively; point 3: top of the aortic arch; points 4 and 5: ventral/dorsal descending aorta and last stent ring, respectively; points 6 and 7: (end of the) brachiocephalic trunk (BCT) (stent); 8 on the BCT bifurcation; points 9 and 10: (end of the) left common carotid artery (LCCA) (stent); 11 on the LCCA bifurcation. The blue-bordered boxes show the path traveled by point 1 during the cardiac cycle in the two scans.
Figure 3.
Figure 3.
The calculated diameters at the three scan moments: preoperative, before discharge and at 5.5 months postoperative, that is, second postoperative scan. Two diameters were calculated at each 1 cm level of the centerline (bright green), forming a diameter pair. Each diameter pair is shown in a different color with a corresponding number. The white diameter pairs indicate the native aorta diameters upstream and downstream of the main body in the aortic arch.
Figure 4.
Figure 4.
The motion amplitudes in x —(lateral), y —(ventral-dorsal), and z —(caudal-cranial) direction and the corresponding pathlengths at the different scan moments (preoperative, discharge and 5.5 months postoperative) in which the motion pattern of each coordinate (X, Y, or Z) is shown in the columns for each point (1–9 as specified in Figure 1). The sum of individual distances between each phase for each point is specified as the traveled pathlength for each point.
Figure 5.
Figure 5.
The (A) static phase-averaged curvature and (B) curvature change of the pre-operative (left), discharge (middle) and 2nd postoperative (right) electrocardiogram (ECG)-gated computed tomography (CT) scan of the brachiocephalic trunk (BCT, blue), left common carotid artery (LCCA, red/orange) and aortic arch (green). The vertical black lines indicate the start and end of the to be stented part of the arteries. CLL, center lumen line.
Figure 6.
Figure 6.
The diameters of the different scan moments (A) and the corresponding cardiac-pulsatility-induced changes in diameter (B) for the diameter pairs along the centerline, spaced at 1 cm of the centerline of the stented aortic arch and a diameter of the of the native aorta upstream (diameter pair 1) and downstream (diameter pair 19) of the stent. The curves show the mean diameter value (calculated from the diameter pair), whereas the filled areas around the curves show the spread of the 2 diameters of each diameter pair.
See this image and copyright information in PMC

References

    1. van Bakel TM, de Beaufort HW, Trimarchi S, et al.. Status of branched endovascular aortic arch repair. Ann Cardiothorac Surg. 2018;7(3):409–416. doi:10.21037/acs.2018.03.13. - DOI - PMC - PubMed
    1. van der Weijde E, Heijmen RH, van Schaik PM, et al.. Total endovascular repair of the aortic arch: initial experience in the Netherlands. Ann Thorac Surg. 2020;109(6):1858–1863. doi:10.1016/j.athoracsur.2019.09.009. - DOI - PubMed
    1. Chen L, Dai X, Wu X, et al.. Ascending aorta and hemiarch replacement combined with modified triple-branched stent graft implantation for repair of acute. Ann Thorac Surg. 2017;103(2):595–601. doi:10.1016/j.athoracsur.2016.06.017. - DOI - PubMed
    1. Zhang L, Lu Q, Zhu H, et al.. Branch stent-grafting for endovascular repair of chronic aortic arch dissection. J Thorac Cardiovasc Surg. 2021;162(1):12–22. doi:10.1016/j.jtcvs.2019.10.184. - DOI - PubMed
    1. Koenrades MA, Struijs EM, Klein A, et al.. Quantitative stent graft motion in ECG gated CT by image registration and segmentation: in vitro validation and preliminary clinical results. Eur J Vasc Endovasc Surg. 2019;58(5):746–755. doi:10.1016/j.ejvs.2019.03.009. - DOI - PubMed

MeSH terms