Preliminary results of one-stage repair of residual aortic dissection using dense mesh stent combined with release and post-processing techniques

Abstract

ObjectiveThis study aims to preliminarily evaluate the early safety and efficacy of one-stage repair of residual aortic dissection using dense metal mesh stents combined with improved release and post-processing techniques.MethodsA prospective, single-center, single-arm clinical trial was designed and implemented, enrolling patients with residual aortic dissection to undergo metal mesh stent implantation under guidance of stent release and post-processing techniques. Patients received aortic CTA follow-up at 30 days post-surgery to assess early safety and efficacy.ResultsA total of 25 patients were enrolled, 14 in the (sub)acute phase and 11 in the chronic phase. No postoperative deaths, reinterventions, or aortic-related adverse events like malperfusion or ischemia were reported. The immediate technical success rate was 100%. For (sub)acute cases, the true lumen volume increased by 176.10%, while the false lumen decreased by 83.95%. False lumen thrombosis was grade II in two patients (14.29%), grade III in seven (50.00%), and grade IV in five (35.71%). For chronic cases, the true lumen volume increased by 96.92%, while the false lumen decreased by 73.43%. Thrombosis was grade II in three patients (27.27%), grade III in five (45.45%), and grade IV in three (27.27%). Postoperative aortic CTA showed that all visceral artery branches remained patent, and high-risk ischemic branches were converted to non-high-risk.ConclusionsPreliminary results suggest that dense mesh stents combined with release and post-processing techniques have acceptable early safety and efficacy. For acute and chronic residual aortic dissection patients with visceral artery branch involvement, this method may offer an alternative treatment option. Registration no. ChiCTR2200055277.

Keywords: Residual aortic dissection; aortic remodeling; dense mesh stent; endovascular repair; release and post-processing technique.

Figure 1.

Schematic diagram of the dense mesh stent and delivery system. (A) Natural state; (B) encapsulated state; (C) ex vivo simulation state; and (D) stent delivery system.

Figure 2.

Stent release and post-processing techniques. (A) Precise stent positioning; (B) segmental compression release; (C) balloon-assisted expansion; and (D) accurate closure of the false lumen tear.

Figure 3.

Schematic diagram of aortic measurements. (A–C) Schematic diagram of the segments of the aorta; D1: aortic diameter; D2: the diameter of the true lumen of the aorta. D1 and D2 are used to confirm the post-deployment diameter of the stent.

Figure 4.

The preoperative and postoperative cross-sectional areas of the aorta at the mid-thoracic aorta level (A), celiac trunk level (B), superior mesenteric artery level (C), right renal artery level (D), left renal artery level (E), and iliac artery level (F).

Figure 5.

Conversion of visceral artery perfusion type. I-c, II-b-2, and III-c represent high-risk ischemic types, while P indicates the postoperative branch type.