Morphological Performance Analysis of a “Nonbare Stent” Stent Graft in Dissected Thoracic Aorta

Objectives: Our aim was to evaluate morphological changes in dissected aortas after thoracic endovascular aortic repair (TEVAR) with the Relay NBS stent graft by focusing on aortic remodeling and the geometrical stent graft’s performance in remodeling aortas.

Methods: We conducted a retrospective 3D CT scan analysis before, postoperatively, and 6 months after TEVAR in patients with residual dissection after type A and those with acute and chronic type B dissections at two German centers.

Results: Thirty-nine chronic and 54 acute aortic dissections were included. Median follow-up lasted 200 (109; 617) days. TEVAR induced aortic remodeling in both groups. Complete false lumen thrombosis along the stent graft (postoperative: 73.2%; follow-up: 83.8%; p < 0.0001) led to a drop in aortic diameter at the mid-stent graft level (preoperative: 45.9 mm [38.6; 56.6] vs. follow-up: 43.6 [37.4; 52.4] mm; p = 0.009). True lumen expansion was observed in both study groups and peaked in acute dissections in the distal landing zone (acute: +9.3 mm vs. chronic: +5.8 mm; p < 0.0001). Migration was 2 (0; 5) mm, and bird beak and endoleak type Ia rates were 20 and 4%, respectively. We observed no retrograde type A dissection. Distal stents induced a new entry in 15.1%, whereby the stent-graft’s wedge apposition was the major risk factor for its incidence (odds ratio: 1.365; 95% confidence interval [1.115–1.671]; p = 0.003).

Conclusion: TEVAR with Relay NBS promotes aortic remodeling in acute and chronic dissections entailing a low risk of migration, type Ia endoleaks, and retrograde type A dissections. Wedge apposition was the predominant risk factor for distal stent-induced new entry.

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