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Italian Journal of Vascular and Endovascular Surgery 2020 September;27(3):146-56

DOI: 10.23736/S1824-4777.20.01445-X


language: English

Early results and lessons learned using the streamliner multilayer flow modulator in the management of complex thoracoabdominal aortic aneurysms and chronic symptomatic aortic dissection

Sherif SULTAN 1, 2 , Jamie CONCANNON 1, 3, J. Patrick McGARRY 3, Peter E. McHUGH 3, Nora BARRETT 1, 2, Niamh HYNES 1, 2

1 Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland; 2 Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland Affiliated Hospitals, Galway, Ireland; 3 Department of Biomedical Engineering, College of Engineering and Informatics, National University of Ireland, Galway, Ireland

BACKGROUND: We report early outcomes of patients with thoracoabdominal aortic aneurysm (TAAA) and chronic symptomatic aortic dissection (CSAD) managed by the streamliner multilayer flow modulator (SMFM).
METHODS: Out of 876 SMFM implanted globally, we have knowledge of 542. To date, 384 patients maintained in the MFM global registry, of which 151 were identified as having an isolated TAAA (39.3%). Aneurysms were classified in accordance with the Crawford Classification including 24 extent I, 35 extent II, 20 extent III, 41 extent IV and 31 extent V aneurysms. Thirty-eight patients were identified as having CSAD (9.8%) of which 35 Stanford Type B dissections, 2 Stanford Type A dissections, and 1 mycotic Stanford Type B dissection.
RESULTS: Overall mortality for TAAA was 17.22% (26 cases); 5 cases of ruptured TAAAs (3.3%) and 10 cases of cardiac related deaths (6.6%) following the primary intervention. Eighty-nine percent of cardiac related deaths involved SMFM that was placed in Zone 5 or above, while only one patient out of those stented in Zone 6 or lower, whom had previous cardiac history of myocardial infarcts died of a cardiac event. All cause survival was 82.7% at 12 months and 67.5% at 24 months. In CSAD patients, there were no reported ruptures or aortic-related deaths. All cause survival was 85.3%. Twelve-month freedom from neurological events was 100%, and there were no incidences of end-organ ischemia, paraplegia or renal insult. A statistically significant reduction in false lumen index (P=0.016) at 12 months, and a borderline significant increase in true lumen volume (P=0.053) confirmed dissection remodelling.
CONCLUSIONS: In TAAA, cardiac related mortality is a concern due to myocardial infarction. However, 80% (4/5) of ruptures occurred within the first two years, which indicates research and development are required for SMFM before its dissemination for TAAA. SMFM is an option in management of complex pan-aortic dissection, it leads to dissection stabilization with no further aneurysm progression, and no retrograde type A dissection. In light of this discovery, more in-depth studies into the correlation between the occurrence of myocardial infarction following stent implantation must be examined, not only relating to the SMFM, but in other commercially available thoracic stents. Until the issues of aneurysm extent and cardiac mortality are answered, TAAA devices will evoke speculation about their compatibility with the environmental properties into which they are being deployed.

KEY WORDS: Aortic aneurysm, thoracic; Myocardial infarction; Pulse wave analysis

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