P167. Improving Aortic Remodeling in Dissection: Factors for Success with Thoracic Endovascular Repair and Bare Metal Stent Extension

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Objectives: This retrospective study aimed to investigate factors influencing aortic remodeling outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR) with the Proximal ExTension to Induce COmplete ATtachment (PETTICOAT) concept for acute complicated Type B aortic dissection (TBAD). The primary objective was to enhance predictability and consistency in aortic dissection therapy by identifying patient-related variables impacting remodeling outcomes.
Methods: The study included 60 "Full PETTICOAT" cases, employing extended bare-metal stents for complete aortic coverage, from a cohort of 299 patients undergoing TEVAR for complicated aortic dissections. The PETTICOAT concept was introduced in March 2015, and patient selection criteria excluded certain endoleaks and cases with short follow-up durations. The study utilized multivariate logistic regression for a detailed analysis of predictors for favorable aortic remodeling.
Results: Among the 60 patients subjected to the full PETTICOAT technique, 37 exhibited stable to good aortic remodeling (favorable remodeling group), while 23 demonstrated poor aortic remodeling (unfavorable remodeling group). The favorable remodeling group had a higher proportion of elderly patients (p=0.012) and a greater frequency of emergent cases (p=0.046). Multivariate analysis pinpointed several independent predictors of favorable aortic remodeling, including age over 60 (OR 9.02, p=0.007), preoperative aortic lumen area under 450mm² (OR 5.74, p=0.035), stent oversizing exceeding 75% of the total aortic lumen (OR 12.72, p=0.041), and oral administration of angiotensin II receptor blockers (ARB) (OR 6.55, p=0.015).
Conclusion: The PETTICOAT concept, utilizing bare-metal stents in conjunction with traditional covered stent grafts, proves highly effective in managing aortic dissections, particularly in elderly patients and those with smaller aortic dimensions. Over a 47.5-month follow-up, it demonstrates positive survival outcomes and comparable aortic event-free survival rates, mitigating risks associated with untreated aortic segments. Age, stent sizing, aortic diameter, and ARB therapy emerge as pivotal predictors of favorable aortic remodeling. Despite promising outcomes, prospective studies are imperative to refine patient selection and optimize technique application for aortic dissection therapy, reinforcing the clinical promise of the PETTICOAT concept in the evolving landscape of aortic interventions.

Authors
Mio Kasai (1), Kenichi Hashizume (1), Mitsuharu Mori (1), Toshiaki Yagami (1), Tadashi Matsuoka (2), Kiyoshi Koizumi (3), Hiroaki Kanayama (3), Yuika Kameda (1), Tsutomu Nara (1), Mayu Nishida (1), Misato Tokioka (1), Hideyuki Shimizu (4)
Institutions
(1) Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, (2) Keio University, Shinjyuku, Tokyo, (3) Ashikaga Red Cross Hospital, Ashikaga, Tochigi, (4) Keio University Hospital, Tokyo, Tokyo

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