Computed tomography-based hemodynamic index for aortic dissection

Xu, Huanming; Xiong, Jiang; Han, Xiaofeng; Mei, Yuqian; Shi, Yue; Wang, Dianpeng; Zhang, Mingchen; Chen, Duanduan

doi:10.1016/j.jtcvs.2020.02.034

Cited by 35 publications

(31 citation statements)

References 26 publications

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“…Hence, we hypothesized that the shorter the PIT-LSA distance, the more susceptible the dissection progression is to complicated hemodynamics, in turn causing more complex morphological change. Xu et al 24 also demonstrated that the shifting of the balance position after TEVAR was associated with aortic remodeling. Although the transmission of force from the true lumen to the false lumen through the PIT is resisted by the covered stent-graft, the residual intimal tears and false lumen branch arteries still influenced the luminal remodeling.…”

Section: Discussionmentioning

confidence: 97%

The Distance From the Primary Intimal Tear to the Left Subclavian Artery Predicts Thoracic Aortic Enlargement After Thoracic Endovascular Aortic Repair of Type B Aortic Dissection: A Retrospective Cohort Study

Rong

et al. 2021

J Endovasc Ther

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Purpose: The purpose of this study was to evaluate the association between the distance from the primary intimal tear (PIT) to the left subclavian artery (LSA) (PIT–LSA distance) and the risk of aortic enlargement after thoracic endovascular aortic repair (TEVAR). Methods: This is a retrospective cohort study. A total of 228 patients were reviewed from the database of the Registry Of type B aortic dissection with the Utility of STent graft (ROBUST) study performed from January 1, 2011, to December 31, 2016. Of them, 196 patients were eligible for analysis. The PIT–LSA distance was defined as the length from the distal edge of the LSA orifice to the proximal edge of the PIT along the centerline of the true lumen. According to the border between zone 3 and zone 4 of the Ishimaru classification, patients were divided into group A (n = 117, PIT–LSA distance ≤ 2 cm) and group B (n = 79, PIT–LSA distance > 2 cm). Thoracic aortic enlargement (TAE) was defined as a thoracic aortic volume increase of ≥20%. Multivariate Cox regression was used to estimate the association between the PIT–LSA distance and risk of TAE after TEVAR. Results: The mean age was 52.3 ± 11.6 years, and 88.8% of patients were male. There were no significant differences between groups in demographic and baseline characteristics. The PIT–LSA distance was 1.1 cm (range, −1.6 to 2.0 cm) in group A, and 2.9 cm (range, 2.1–12.6 cm) in group B. TAE occurred in 27 patients in group A, and 6 in group B. The mean follow-up was 12.4 months (range, 0.10–83.1 months) in group A, and 12.63 months (range, 0.10–82.77 months) in group B. The cumulative 12- and 24-month rates of freedom from TAE were 79.0% and 71.3% in group A, versus 92.5% and 92.5% in group B, respectively. Multivariate Cox regression analysis revealed that the PIT–LSA distance was an independent predictor of TAE after TEVAR (adjusted hazard ratio, 0.66; 95% confidence interval, 0.48–0.90; p = 0.009). Conclusion: Patients with a more proximal PIT location have a higher incidence of thoracic aortic enlargement after TEVAR. The location of the PIT in relation to the LSA can be used to identify patients who need closed surveillance after TEVAR or early preemptive intervention.

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Section: Discussionmentioning

confidence: 97%

The Distance From the Primary Intimal Tear to the Left Subclavian Artery Predicts Thoracic Aortic Enlargement After Thoracic Endovascular Aortic Repair of Type B Aortic Dissection: A Retrospective Cohort Study

Rong

et al. 2021

J Endovasc Ther

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“…Therefore, Fabulous possesses a lower elastic recoil force, and the damage to the intima was reduced. Moreover, there was study used computational hemodynamics and 3D structural analysis to illustrate the flow and the wall motion ( 24 ). And they reported that the first balance position of the lumen pressure played a critical role in aortic remodeling, which is a novel point of view.…”

Section: Discussionmentioning

confidence: 99%

Clinical Results and Aortic Remodeling After Endovascular Treatment for Complicated Type B Aortic Dissection With the “Fabulous” Stent System

Wang

Kan

Yang

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTo report the clinical outcomes and aortic remodeling after the implantation of a self-developed, biomechanically optimized, two-stage thoracic stent system named Fabulous.BackgroundGiven the efficacy of the PETTICOAT concept, the benefits of Fabulous and the behavior of remodeling in different segments need further investigation.MethodsThis is a prospective and multicenter study. From 2017 to 2019, 145 patients (mean age, 56.6 years; 88.3% male) from 14 centers were included in this cohort. The clinical results and core laboratory results were from a central electronic data capture system. Computed tomographic angiography was performed preoperatively, 1 month, 6 months and yearly thereafter and was used for volumetric analysis by 3mensio (Bilthoven, The Netherlands). After the 1-year follow-up, 97.2 and 87.6% of the clinical and imaging results of the eligible patients were available.ResultsBoth stent grafts and bare stents were successfully delivered in place in 100% of the patients. The 30-day mortality and 1-year freedom from all-cause mortality were 2.1 and 96.6%, respectively. The incidence of entry flow was 11.7% at 30 days and 6.2% at 365 days. No cases of stent-induced new entry (SINE) or reintervention were observed. After the 1-year follow-up, the true lumen/overall volume ratio reached 88%. The following subdivided segment volume changes were recorded: stent graft segment TL +56%; FL −92%, bare stent segment TL +32%; FL −75%, and there were no significant changes in the visceral segment.ConclusionsThese outcomes indicated that there were favorable clinical benefits of Fabulous stent system. This device achieved a low short-term mortality and a low incidence of reintervention. In addition, patients undergoing Fabulous stent system implantation showed remodeling both on descending aorta and on the distal aorta. The volume changes in the TL and FL varied in the different segments. The long-term follow-up is still ongoing.

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“…The flow pattern, the luminal flow exchange via the tears, the relative residence time that was related to thrombosis development, the luminal pressure interaction, etc. were quantitatively studied ( Cheng et al, 2015 ; Xu et al, 2017 ; Xu et al, 2018 ; Pirola et al, 2019 ; Xu et al, 2020 ). Recently, we proposed a functional indicator to quantify the hemodynamic benefit by TEVAR and to predict post-TEVAR prognosis ( Xu et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator

Armour

et al. 2022

Front. Bioeng. Biotechnol.

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Thoracic endovascular aortic repair (TEVAR) is a common treatment for Stanford type B aortic dissection (TBAD). However, re-entry tears might be found distal to the stented region which transports blood between the true and false lumens. Sealing the re-entry tears, especially for the thoracic tears, could further reduce blood perfusion to the false lumen; however, it might also bring risks by re-intervention or surgery. Wise determination of the necessity to seal the re-entry tears is needed. In this study, patient-specific models of TBAD were reconstructed, and the modified models were established by virtually excluding the thoracic re-entries. Computational hemodynamics was investigated, and the variation of the functional index and first balance position (FBP) of the luminal pressure difference, due to the sealing of the re-entries, was reported. The results showed that the direction of the net flow through the unstented thoracic re-entries varied among cases. Excluding the re-entries with the net flow toward the false lumen may induce the FBP moving distally and the relative particle residence time increasing in the false lumen. This study preliminarily demonstrated that the hemodynamic status of the re-entry tears might serve as an indicator to the necessity of sealing. By quantifying the through-tear flow exchange and shift of FBP, one can predict the hemodynamic benefit by sealing the thoracic re-entries and thus wisely determine the necessity of further interventional management.

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Computed tomography-based hemodynamic index for aortic dissection

Cited by 35 publications

References 26 publications

The Distance From the Primary Intimal Tear to the Left Subclavian Artery Predicts Thoracic Aortic Enlargement After Thoracic Endovascular Aortic Repair of Type B Aortic Dissection: A Retrospective Cohort Study

The Distance From the Primary Intimal Tear to the Left Subclavian Artery Predicts Thoracic Aortic Enlargement After Thoracic Endovascular Aortic Repair of Type B Aortic Dissection: A Retrospective Cohort Study

Clinical Results and Aortic Remodeling After Endovascular Treatment for Complicated Type B Aortic Dissection With the “Fabulous” Stent System

The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator

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