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Dynamic Indicators That Impact the Outcomes of Thoracic Endovascular Aortic Repair in Complicated Type B Aortic Dissection
Affiliation:1. Department of Radiology, Shandong Provincial Hospital, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, China;2. Department of Radiology, Shandong Medical Imaging Research Institute, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, Jinan, Shandong 250021, China;3. Siemens Healthcare Diagnostics Shanghai Co Ltd, Shanghai, China;1. College of Medicine, Penn State University, Hershey, Pennsylvania;2. Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, San Diego, California;3. Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin;4. Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio;5. Department of Radiology, Division of Vascular and Interventional Radiology, Stanford University, 300 Pasteur Drive, H3630, Stanford, CA 94305;1. Department of Urology, Weill Cornell Medicine–New York Presbyterian Hospital Network, 525 E. 68th St., Starr 946, New York, NY 10065;2. Department of Radiology, Weill Cornell Medicine–New York Presbyterian Hospital Network, 525 E. 68th St., Starr 946, New York, NY 10065;3. Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York;4. Department of Radiology, Jacobi Medical Center/Albert Einstein College of Medicine, New York, New York;1. Department of Medical Imaging, Division of Interventional Radiology, Western University, 1151 Richmond St, London, ON, Canada, N6A 5A5;2. Lawson Health Research Institute, London, Ontario, Canada;1. Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany;2. Department of Neuroradiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany;3. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Sheng, China;4. Department of General Pathology, University Hospital Mainz, Mainz, Germany;5. Clinic for Radiology, Minimally-invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Heilbronn, Germany;6. Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany;1. Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India;2. Cardiovascular and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India;1. Department of Interventional Radiology, Nouvel Hôpital Civil, 1 place de l’hôpital, 67096 Strasbourg, France;2. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
Abstract:PurposeTo investigate dynamic variables obtained from retrospective computed tomography angiography for ability to predict thoracic endovascular aortic repair (TEVAR) outcomes in patients with complicated type B aortic dissection (cTBAD).Materials and MethodsSeventy-nine patients with cTBAD who received TEVAR from March 2009 to June 2018 were retrospectively enrolled. Relative true lumen area (r-TLA) was computed at the level of tracheal bifurcation every 5% of all R-R intervals. Parameters that reflect the state of intimal motion were evaluated, including difference between maximum and minimum r-TLA (D-TLA) and true lumen collapse. The endpoints comprised early (≤ 30 days) and late (> 30 days) outcomes after intervention.ResultsOverall early mortality rate was 13.9% (11/79), and early adverse events rate was 24.1% (19/79). Patients who received TEVAR within 2 days of symptom onset demonstrated the worst outcomes. A longer time of r-TLA < 25% in 1 cardiac cycle (P = .049) and larger D-TLA (P < .001) were correlated to an increased early death. In addition, D-TLA was an independent predictor of early mortality. Area under the curve of D-TLA was 0.849 (95% confidence interval 0.730–0.967) for predicting early mortality and 0.742 (95% CI 0.611–0.873) for predicting early adverse events. Survival and event-free survival rates during follow-up were decreased in the D-TLA > 21.5% group compared with the D-TLA ≤ 21.5% group (all P < .001).ConclusionsLarger D-TLA is correlated with worse postoperative outcomes and might be a crucial parameter for future risk stratification in patients with cTBAD.
Keywords:AEs"}  {"#name":"keyword"  "$":{"id":"kwrd0015"}  "$$":[{"#name":"text"  "_":"adverse events  CI"}  {"#name":"keyword"  "$":{"id":"kwrd0025"}  "$$":[{"#name":"text"  "_":"confidence interval  cTBAD"}  {"#name":"keyword"  "$":{"id":"kwrd0035"}  "$$":[{"#name":"text"  "_":"complicated type B aortic dissection  D-TLA"}  {"#name":"keyword"  "$":{"id":"kwrd0045"}  "$$":[{"#name":"text"  "_":"difference between maximum and minimum relative true luminal area  ECG"}  {"#name":"keyword"  "$":{"id":"kwrd0055"}  "$$":[{"#name":"text"  "_":"electrocardiogram  LSA"}  {"#name":"keyword"  "$":{"id":"kwrd0065"}  "$$":[{"#name":"text"  "_":"left subclavian artery  r-TLA"}  {"#name":"keyword"  "$":{"id":"kwrd0075"}  "$$":[{"#name":"text"  "_":"relative true luminal area  TEVAR"}  {"#name":"keyword"  "$":{"id":"kwrd0085"}  "$$":[{"#name":"text"  "_":"thoracic endovascular aortic repair  TLC"}  {"#name":"keyword"  "$":{"id":"kwrd0095"}  "$$":[{"#name":"text"  "_":"true lumen collapse  time of relative true lumen area < 25% in a cardiac cycle
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