Li Xianwei, Zhang Yingnan, Sun Zhanfeng, Wang Haitao, Zhang Chuanqi, Cui Yunfu, Jiang Weiliang
Department of Vascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
J Thorac Cardiovasc Surg. 2024 Jan;167(1):28-38.e8. doi: 10.1016/j.jtcvs.2022.01.042. Epub 2022 Feb 5.
Distal stent graft-induced new entry (dSINE) can occur after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). In this study we aimed to compare the effectiveness of restrictive bare stent (RBS), tapered stent graft (TSG), and non-TSG in TEVAR in preventing dSINE after a midterm follow-up.
This retrospective cohort study included patients with TBAD who underwent TEVAR (June 2010 to December 2018). The occurrence of dSINE during follow-up was examined. Predictors of dSINE were determined using Fine-Gray regression with death as the competing event. Survival was evaluated using Cox proportional hazards regression.
Finally, 364 patients were included: 111 with non-TSG TEVAR, 125 with TSG TEVAR, and 128 with TEVAR with RBS. After 54.5 months, incidences of dSINE in the 3 groups were 12.61%, 4.80%, and 1.56%, respectively (P = .002). On Fine-Gray regression adjusted for clinically relevant covariates, the expansion mismatch ratio (subdistribution hazard ratio, 1.09; 95% CI, 1.07-1.12; P < .001) and complete false lumen thrombosis (subdistribution hazard ratio, 0.35; 95% CI, 0.13-0.94; P = .037) were identified as predictors of dSINE. The Cox proportional hazards regression analysis revealed that dSINE was not only a risk factor for aortic-related mortality (hazard ratio, 17.90; 95% CI, 3.27-98.12; P = .001), but also a predominant risk factor for all-cause mortality (hazard ratio, 4.91; 95% CI, 1.66-14.52; P = .004).
dSINE can happen in TBAD patients who undergo TEVAR. Thus, long-term surveillance is crucial. TSG and RBS had lower expansion mismatch ratios, which might help prevent dSINE.
在B型主动脉夹层（TBAD）的胸主动脉腔内修复术（TEVAR）后，可能会发生远端支架移植物诱导的新破口（dSINE）。在本研究中，我们旨在比较限制性裸支架（RBS）、锥形支架移植物（TSG）和非TSG在TEVAR中期随访后预防dSINE的有效性。
这项回顾性队列研究纳入了接受TEVAR的TBAD患者（2010年6月至2018年12月）。检查随访期间dSINE的发生情况。以死亡作为竞争事件，使用Fine-Gray回归确定dSINE的预测因素。使用Cox比例风险回归评估生存率。
最终纳入364例患者：111例行非TSG TEVAR，125例行TSG TEVAR，128例行RBS TEVAR。54.5个月后，3组中dSINE的发生率分别为12.61%、4.80%和1.56%（P = 0.002）。在针对临床相关协变量进行调整的Fine-Gray回归中，扩张不匹配率（亚分布风险比，1.09；95% CI，1.07 - 1.12；P < 0.001）和完全假腔血栓形成（亚分布风险比，0.35；95% CI，0.13 - 0.94；P = 0.037）被确定为dSINE的预测因素。Cox比例风险回归分析显示，dSINE不仅是主动脉相关死亡率的危险因素（风险比，17.90；95% CI，3.27 - 98.12；P = 0.001），也是全因死亡率的主要危险因素（风险比，4.91；95% CI，1.66 - 14.52；P = 0.004）。
dSINE可发生在接受TEVAR的TBAD患者中。因此，长期监测至关重要。TSG和RBS的扩张不匹配率较低，这可能有助于预防dSINE。
