Purpose:The aim of this comparative study was to evaluate the increased aortic diameter of the distal aorta after implementing the STABILISE technique in complicated type B aortic dissection (AD).Design:This is a comparative monocentric retrospective study.Materials and Methods:All patients who underwent an STABILISE procedure for complicated AD between 2018 and 2020 were included and compared with a historic cohort treated with thoracic endovascular aortic repair (TEVAR) alone. Aortic diameters were measured at 6 different levels on the thoracic and abdominal aorta. The primary end point was an increased aortic diameter at 1 and 2 years. The exclusion criterion was the absence of a computed tomography (CT) scan at 1 or 2 years.Results:A total of 55 patients were included: 24 in the TEVAR group and 31 in the STABILISE group. At the level of the stent graft, there was a decrease in aortic diameters in both groups without significant differences. At the level of the distal aorta, there was an increase in aortic diameters in both groups without significant differences. There were significantly more patients in the TEVAR group with an unfavorable increase in aortic diameter >5 mm of the distal aorta at 2 years than in the STABILISE group: 8 (33%) vs 1 (3%) (p=0.01). For chronic ADs, a significantly greater increase in aortic diameters of the distal aorta was observed in the STABILISE group.Conclusions:The STABILISE technique is technically feasible and potentially leads to decreased longer re-intervention rates; indeed, more patients had an unfavorable increase in aortic diameter in the TEVAR group than in the STABILISE group at 2 years. The high rate of long-term distal aortic aneurysm progression and reintervention after TEVAR alone suggests that this option is not sufficient to definitively treat these complex patients.Clinical ImpactThis article reported the results of stent assisted balloon induced intimal disruption and relamination (STABILISE) with a follow-up at 2 years. This is the first comparative study between STABILISE, which has emerged as a new technique inducing aortic remodeling and therefore better long-term outcome, and the standard technique TEVAR alone. STABILISE technique is associated with good results on the distal aorta at 2 years with a rate of patient with unfavorable aortic diameter evolution greater in TEVAR group compared to STABILISE group and could improve the long-term results on the distal aorta by inducing extensive aortic remodeling.

中文翻译：

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STABILIZE（主动脉夹层修复中支架辅助球囊诱导的内膜破裂和再层叠）与 2 岁时远端胸腹主动脉的良好解剖结果相关

目的：本比较研究的目的是评估复杂 B 型主动脉夹层 (AD) 实施稳定技术后远端主动脉直径的增加。设计：这是一项比较单中心回顾性研究。材料和方法：所有患者2018 年至 2020 年间因复杂 AD 接受 STABILIZE 手术的患者被纳入研究，并与仅接受胸主动脉腔内修复术 (TEVAR) 治疗的历史队列进行比较。在胸主动脉和腹主动脉的 6 个不同水平上测量主动脉直径。主要终点是 1 年和 2 年时主动脉直径增加。排除标准是 1 或 2 年内未进行计算机断层扫描 (CT) 扫描。 结果：总共纳入 55 名患者：TEVAR 组 24 名，STABILIZE 组 31 名。在支架移植物水平上，两组的主动脉直径均有所减小，但没有显着差异。在远端主动脉水平，两组的主动脉直径均有所增加，但没有显着差异。TEVAR 组中 2 年时远端主动脉直径不利增加 > 5 mm 的患者明显多于 STABILIZE 组：8 例 (33%) vs 1 例 (3%) (p=0.01)。对于慢性 AD，在 STABILIZE 组中观察到远端主动脉直径显着增加。结论：STABILIZE 技术在技术上是可行的，并且可能会降低较长时间的再干预率；事实上，2 年时 TEVAR 组的主动脉直径出现不利增加的患者数量比 STABILIZE 组的患者要多。单独 TEVAR 后长期远端主动脉瘤进展和再干预的高发生率表明，这种选择不足以彻底治疗这些复杂的患者。 临床影响本文报道了支架辅助球囊诱导内膜破裂和再分层 (STABILISE) 的结果2年随访。这是 STABILISE 与标准技术 TEVAR 之间的第一项比较研究，STABILISE 已成为一种诱导主动脉重塑并因此获得更好的长期结果的新技术。STABILIZE 技术与 2 年时远端主动脉的良好结果相关，与 STABILIZE 组相比，TEVAR 组出现不利主动脉直径演变的患者比例更高，并且可以通过诱导广泛的主动脉重塑来改善远端主动脉的长期结果。