Dottorato in FISIOPATOLOGIA ED IMAGING CARDIO-TORACO-VASCOLARE

Titolo della tesi: TYBE B AORTIC DISSECTION TREATMENT: HOW THE STABILISE TECHNIQUE HAS CHANGED THE PARADYGM OF TREATMENT

Introduction Endovascular treatment has progressively become the mainstay in managing type B aortic dissection (TBAD), yet long-term real-world data across different techniques remain limited. While TEVAR has revolutionized the management of complicated dissections by promoting false lumen thrombosis and aortic remodeling, it often fails to achieve complete re-expansion and healing of the true lumen throughout the dissected segment. The STABILISE technique was designed to overcome these limitations by promoting complete aortic relamination, leading to a single-channel aorta and improved long-term outcomes. Materials and Methods Data on all patients treated for TBAD both in elective and urgent setting by endovascular means from January 2018 to October 2024 were included in the present study. Patients were classified according to the European criteria for complicated/uncomplicated type B aortic dissection and its time-related phases. Technical success was defined as the accurate endograft deployment within the true lumen, without aortic or device-related complication. Clinical success was defined as the resolution of the symptoms, after endovascular treatment. Results During the study period, 51 patients (46 male, 5 female) met the inclusion criteria, with a mean age of 62.6 ± 11.0 years (range, 45–83). They were submitted to: TEVAR (n = 17, 33.3%), STABILISE (n = 21, 41.2%), PETTICOAT (n = 6, 11.8%), and other procedures (n = 7, 13.7%). In the STABILISE group, 6 patients (28,57%) were submitted to the intervention using the CASTOR single-branched graft (MicroPort Endovascular, Shanghai, China). No intraoperative deaths or major complications occurred, and technical success was achieved in all cases (100%). A peri-procedural cerebral complication occurred 24 hours after an emergent TEVAR procedure for a complicated Type B Aortic Dissection. Perioperative (within 30 days) aorta-related complications occurred in 6 patients (11,76%). 30-days post-operative death was recorded in 2 patients: both patients died due to acute respiratory failure. At 1 year, no death was recorded. Cerebral complications, not intervention related, were recorded in 2 cases. No cardiac, renal, cardiac complications nor spinal cord ischemia were recorded. However, at 1 year, 5 patients (9,8%) were lost to follow-up. In the remaining cases, all visceral vessels remained patent at the 12 months control CTA. Concerning the FL, there was a complete FL thrombosis in 35 patients (79,54%), (10 cases of TEVAR, 21 cases of STABILISE, 1 case of PETTICOAT, 3 case other): in 34 (97,14%) already present at the 6 month CTA, while in the remaining 1 a partial thrombosis was present; a partial one in 8 patients (18,18%), stable from the 6 month CTA in all cases, a complete patency persisted 1 case (2,28%). Conclusion The STABILISE technique clearly demonstrates superiority over other endovascular techniques in the treatment of Type B aortic dissection. By achieving complete aortic remodeling, true lumen restoration, and near-total false lumen thrombosis, it provides a more definitive and durable endovascular repair. These results confirm that STABILISE establishes a stable aortic architecture that minimizes late complications and reinterventions.