Comparison Of Short-Term Aortic Remodeling Between TEVAR And TEVAR+RBS In The Treatment Of Stanford B Dissection With True Lumen Stenosis

OBJECTIVE: To investigate whether TEVAR + RBS is superior to TEVAR for short-term aortic remodeling in patients with type B aortic dissection.METHODS: The clinical and imaging data of 171 patients with Stanford B type thoracic aortic dissection diagnosed in our hospital between January 2014 and December 2018 were retrospectively analyzed.13 patients who met the criteria of this study were screened out.Among them,6 patients underwent TEVAR combined with RBS(TEVAR+RBS group),and 7 patients underwent TEVAR alone(TEVAR+RBS group).The aortic remodeling was evaluated by comparing the CTA data of the two groups before and after operation.RESULTS: The operation was successful in both groups.No paraplegia,stroke,poor perfusion syndrome,aortic rupture or progression to Stanford A type dissection occurred.In TEVAR+RBS group,the average overlap length between covered stent and restricted bare stent was about 45.0 ±12.7 mm.In this study,the imaging measurements of different aortic layers included the diameter(short diameter)and area of the true and false aortic lumen on three layers: the bronchial bifurcation layer,the end layer of covered stent and the diaphragm angle layer.In TEVAR+RBS group,compared with TEVAR group,the increase rate of true cavity diameter(237% vs 106%,P = 0.019),the decrease rate of false cavity diameter(49% vs 25%,P = 0.04),the increase rate of true cavity area(321% vs 153%,P = 0.037),the decrease rate of false cavity area(38%vs 0%,P = 0.008),the increase rate of true cavity diameter at diaphragm angle(152% vs 23%,P = 0.039),and the decrease rate of false cavity diameter(31% vs 7%,P = 0.031),and the increase rate of true cavity area(89% vs 26%,P = 0.048),there were statistical differences between groups.There were no significant differences in the true cavity diameter enlargement rate(100% vs 104%,P = 0.932),false cavity diameter reduction rate(31% vs 36%,P = 0.693),true cavity area enlargement rate(136% vs 121%,P = 0.780),false cavity area reduction rate(39% vs 1%,P = 0.068)and false cavity area reduction rate(10% vs-6%,P = 0.119)at the angle of diaphragm between the two groups.CONCLUSION: 1.Short-term aortic remodeling in TEVAR+RBS group is better than that in TEVAR group at the end of covered stent and diaphragm angle level.2.Short-term aortic remodeling is worse at diaphragm angle level than at tracheal bifurcation level or the end of covered stent in both two groups.