Efficacy Analysis Of Proximal Bare And Non-bare Covered Stents Interventional Therapy Of Retrograde Stanford Type A Aortic Intermural Hematoma

Objective:Summarizing the results and experience of thoracic endovascular aortic repair(TEVAR)in the treatment of retrograde type A aortic intramural hematoma(re-TAIMH),to evaluate the safety and short and medium term efficacy of interventions with proximal bare and non-bare covered stents in patients with re-TAIMH for clinical decision-making.Materials and methods:Data were collected on 97 patients who were diagnosed with re-TAIMH and treated with TEVAR in the Second Affiliated Hospital of Nanchang University from January 2018 to December 2021.According to the proximal end of the covered stent with or without bare metal area,the clinical data of the two groups(the proximal bare stent group and the non-bare stent group)were retrospectively analyzed,including basic patient data,intraoperative data,postoperative complications,mortality and aortic remodeling.Outcome:All 97 patients included 69 males and 28 females.Fifty-five patients received proximal bare Stent stent intervention,and 42 patients received proximal non-bare Stent stent intervention,and the success rate of surgery was 100%.58 patients presented with obvious intimal disruption at distal aortocarptic arch,32 of whom were treated with proximal bare Stents,and 26 proximal non-bare covered stents.39 patients presented with hidden intimal disruption at distal aortocarptic arch,23 of whom were treated with proximal bare Stents,and 16 proximal non-bare covered stents.The median follow-up time of the two groups was 24.0(18.0,29.0)months and23.5(16.0,30.2)months.There are 9 cases of internal leakage in the proximal bare stent group after surgery,of which 1 case was found to be obvious type IA internal leakage 3 days after surgery and re-interventional treatment,8 cases were found to have micro type II internal leakage during postoperative follow-up,while 1 case was found in the proximal non-bare stent group after postoperative follow-up,and the difference between the two groups was statistically significant(P =0.040).In the proximal bare stent group,4 patients with secondary surgery were counted;in the proximal non-bare stent group,only 1 patient.There were four cases of retrograde aortic dissection in the proximal bare stent group after surgery,and two of the patients died suddenly,which was clinically considered to be caused by the rupture of retrograde retrograde aortic dissection.The secondary postoperative surgery and retrograde aortic dissection events of the two groups ware no statistically significant difference(P > 0.05).There was one case of death due to massive cerebral infarction on the 3rd postoperative day in the proximal bare stent group,and no in-hospital death in the proximal non-bare stent group.During the post-discharge follow-up period,one patient in the proximal bare stent group died of acute myocardial infarction 15 months after surgery,and one patient in proximal non-bare stent group died due to ineffective hospitalization for right thalamic hemorrhage one year after surgery.With the prolongation of postoperative time,the improvement of aortic remodeling indexes in both groups gradually increased,and the parallel comparison between the two groups was not statistically significant(P > 0.05).The 2-year cumulative survival rate for all patients was 94.85%.Conclusion:For suitable patients with retrograde Stanford Type A aortic intermural hematoma,especially those with relatively inadequate proximal anchorage areas,it is safer and more effective to choose the proximal non-bare covered stents than the proximal bare covered stents for TEVAR.