Acute Type B Aortic Dissection Research Articles

Introduction: Type B Aortic Dissection (TBAD) is a lethal disease. The dissection flap demonstrates morphologic and biomechanical changes as the dissection transitions from the acute to chronic phase. This study sought to delineate the changes in flap thickness in TBAD and to elucidate the relationship between flap thickness and patient-specific wall shear stress (WSS). Hypothesis: We hypothesized that the TBAD dissection flap thickens during the transition from acute to chronic phase, and the growth rate of the flap thickness is mediated by the WSS. Methods: A total of 18 computed tomography (CT) images were retrospectively analyzed from nine TBAD patients treated with optimal medical therapy, with each patient having two scans (Scan 1: acute phase; Scan 2: chronic phase). The flap thickness was measured from the CT cross-section (Fig. 1a and 1b) at three locations, approximately evenly distributed in the longitudinal direction of the flap, for Scan 1 and Scan 2 of each patient. Patient-specific computational fluid dynamics (CFD) was performed based on the CT-derived three-dimensional geometry of the TBAD (Scan 1), and the WSS at the same location as the measured flap thickness was obtained from the CFD flow profile. Results: The flap thickness at a total of 54 locations was obtained in the acute (n=27) and chronic (n=27) phase of the nine TBAD patients. Statistical analyses (Fig. 1c) showed that the flap thickness increased significantly as the acute TBAD transitions to the chronic phase (1.275±0.035 mm vs. 1.535±0.041 mm, p<0.001). The WSS has a strong positive correlation with the flap thickness growth rate (Fig. 1d, R=0.8261, p<0.001). Conclusions: The dissection flap thickens as the aorta transitions from the acute to chronic phase in TBAD, and regions exposed to higher WSS exhibit faster growth. These findings implicate hemodynamic loading as a key mediator of flap remodeling and highlight WSS as a potentially actionable target for risk stratification and therapeutic planning in chronic TBAD.

Aortic morphology plays a critical role in determining treatment pathways and predicting outcomes in patients presenting with acute type B aortic dissection (TBAD). However, there is no consensus on the optimal methodology for the morphological assessment of TBAD. This study aims to demonstrate the reproducibility of a comprehensive imaging protocol for the analysis of aortic morphology of TBAD for clinical and research purposes. Protocol for comprehensive assessment of TBAD morphology was designed based on systematic review and expert opinion. A total of 56 morphological parameters were assessed across 6 morphological domains: aortic arch, aortic measurement, dissection morphology, false lumen morphology, endovascular intervention, and aortic remodeling. To validate the protocol, 4 observers measured these variables on 20 computed tomographic angiograms (CTAs) on a total of 10 patients using 3-dimensional imaging reconstruction software. One observer performed repeated measurements. The intraobserver and interobserver variabilities were calculated for all continuous variables. Cohen's kappa was used to assess agreement between observers for categorical variables. Measurement time for all 56 features was recorded. Aortic arch, false lumen morphology, endovascular intervention, and aortic remodeling showed strong levels of agreement. Aortic measurements, including aortic diameter and false lumen diameter, showed satisfactory intraobserver and interobserver variabilities with maximum repeatability coefficient (RC) for interobserver variability of 5.02 mm and intraobserver variability of 2.42 mm across all measurements. False lumen thrombosis assessment revealed moderate to almost perfect agreement (κ range=.58-1) and almost perfect intraobserver agreement (κ range=1-1). Entry tear morphology, including primary entry tear (PET) size and distance from left subclavian artery (LSCA), showed small mean differences but was associated with high RCs. Location of PET lesser curve location was found to have moderate to almost perfect interobserver agreement (κ range=.58-1) and strong intraobserver agreement (κ=.73). The measurement protocol was completed in a median time of 28 (24, 35) minutes. Accurate 3-dimensional analysis of TBAD morphology can be reliably performed within a reasonable timeframe. Measurements based on consistent anatomical landmarks demonstrated the highest reproducibility. It is suggested that this protocol is adopted for clinical studies and trials on acute TBAD.Clinical ImpactThe morphological characteristics of the aorta play a pivotal role in guiding treatment strategies and prognosticating outcomes in patients with acute type B aortic dissection (TBAD). Despite its critical importance, there remains a lack of consensus regarding the optimal approach to the morphological assessment of TBAD. This study presents a standardized and internally validated protocol for the evaluation of aortic morphology. The proposed methodology is intended to facilitate both clinical decision-making and research endeavors in the context of acute TBAD.

Early Thoracic Endovascular Aortic Repair for Acute Type B Dissection Is Associated with Increased Complications: Results from the Gore Global Registry for Endovascular Aortic Treatment Registry.

ObjectiveFalse lumen expansion is a major factor that determines long-term survival of uncomplicated type B aortic dissection (TBAD). The objective of this study was to investigate whether structural wall stress distributions computed from patient-specific acute TBAD geometries can be used to predict aortic growth rates.MethodsThree-dimensional (3D) computed tomography angiography (CTA) of 9 patients with acute uncomplicated TBAD were obtained at initial hospital admission and at their most recent follow-up visits. Patient-specific structural wall stress distributions were computed from the initial baseline CTA using a forward penalty method. Spatially varying blood pressure distributions, derived from computational fluid dynamics (CFD) simulations informed by patient-specific transthoracic echocardiography (TTE) and blood pressure (BP) measurements, were incorporated into the forward penalty stress analysis. Aortic growth rates were quantified and visualized within the 3D TBAD geometries using the initial baseline and follow-up scans. Linear mixed-effects regression analyses were performed to evaluate the spatial correlations between biomechanical markers (structural wall stress, wall shear stress, and pressure) and aortic growth rates.ResultsUtilizing initial baseline CTA, TTE, and BP data, the forward penalty analyses revealed hemodynamic and structural mechanics insights of acute uncomplicated TBADs. The linear mixed-effects model indicated that the fixed-effect association between structural wall stress and aortic growth rate distributions was statistically significant (p=0.039), which demonstrated that aortic segments experiencing high wall stress exhibited rapid growth. Fixed-effect associations were not significant when predicting growth rate using wall shear stress (p=0.86) or pressure (p=0.61) distributions. Significant Pearson correlation coefficients (p<0.05) were observed between structural wall stress and aortic growth rate in all patients.ConclusionHigh structural wall stress was associated with regions of high aortic growth rates, while false lumen thrombosis was associated with low wall stress. Structural wall stress derived from the forward penalty approach may be a novel predictor of aortic growth rate and failure of optimal medical therapy in acute TBAD.

Pre-Emptive Endovascular Repair for Uncomplicated Type B Dissection - Is This an Option?

Low rates of aortic surveillance imaging and clinical follow-up in patients with acute aortic dissection.

Quality of Life, Anxiety and Depression after Acute Type B Aortic Dissection.

This study sought to investigate the temporal variations in serum calcium concentrations among patients with acute type B aortic dissection (ATBAD) following initial diagnosis, document the incidence of severe complications, and evaluate their potential associations. In this retrospective analysis, we examined 42 consecutive patients diagnosed with ATBAD at Zhejiang Hospital between April 2019 and April 2024. Serum-ionized calcium levels were measured at admission and 24 hours post-admission. Based on changes in calcium levels, patients were categorized into either the elevated or decreased groups. Univariate and multivariate logistic regression analyses were performed to compare clinical characteristics and assess the incidence of severe complications following the initial diagnosis. The study further explored the association between 24-hour serum calcium levels, their dynamic changes, and the occurrence of severe complications in patients with ATBAD. The results showed that the decreased group had a significantly higher frequency of severe complications, including mortality, cardiac complications, acute renal failure, and organ hypoperfusion (P < 0.05), while no significant differences were observed for neurological or pulmonary complications (P > 0.05). Logistic regression revealed that a decline in serum calcium levels within 24 hours was an independent risk factor for severe complications (OR = 16.722, P = 0.03). The receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.864. Decreased serum calcium concentration is an independent predictor of severe complications in ATBAD patients, significantly associated with mortality, cardiac complications, acute kidney injury, and inadequate organ perfusion. No significant correlation with neurological and pulmonary complications was observed.

Objectives: To assess the long-term efficacy and safety of thoracic endovascular aortic repair (TEVAR) in the treatment of acute type B aortic dissection (ATBAD), emphasizing endpoints such as survival, re-intervention rates and complications throughout prolonged follow-up periods. Methods: An exhaustive search of the four databases yielded 1016 pertinent papers. Following the elimination of duplicates with the Rayyan QCRI and the assessment for relevance, 93 full-text publications were examined, with eight studies eventually satisfying the inclusion requirements. Results: Eight years of study on patients with ATBAD found a long-term mortality rate of 7.7% in uncomplicated cases and 78% in complicated cases, with a total mortality rate of 311 (10%). The post-operative complications and re-intervention rates varied. Preoperative inflammatory and lipid profiles are key predictors of mortality risk. Conclusion: TEVAR, a treatment for ATBAD, has shown potential long-term benefits. However, patient selection should be individualized based on risk factors and anatomical characteristics. Further research is needed to validate these findings, refine clinical guidelines and improve the safety and efficacy of TEVAR in diverse patient populations to ensure optimal treatment outcomes.

To analyze the clinical efficacy of long-term statin therapy following thoracic endovascular aortic repair (TEVAR) in patients with acute type B aortic dissection (ATBAD). We retrospectively analyzed data from 645 patients treated between January 2005 and June 2022, dividing them into Statin Group (n=330) and Non-statin Group (n=315) based on whether they received long-term postoperative statin therapy. Patients were further categorized based on median admission low-density lipoprotein cholesterol (LDL-C) levels into High and Low LDL-C Groups to assess the effect of statins on the prognosis of ATBAD patients after TEVAR. The cohort had an average age of 53.44±11.42 years old, and 81.71% were male. Statin therapy significantly reduced occurrences of all-cause death (3.03% vs 8.57%, p=0.002) and aorta-related death (0.91% vs 3.81%, p=0.015), particularly in patients with high admission LDL-C levels. In addition, patients with statin therapy had a lower incidence of aorta-related adverse events (ARAE) (4.24% vs 11.11%, p=0.001). Kaplan-Meier analysis indicated statins reduced 5-year cumulative incidence rates of all-cause death and ARAE (all Log-rank p<0.05). These trends were sustained after adjustment. Multivariate Cox analysis confirmed that statin therapy was associated with reduced risks of all-cause and aorta-related deaths, as well as ARAE. Long-term statin therapy appears to decrease the risk of all-cause and aorta-related death in ATBAD patients after TEVAR, particularly patients with high admission LDL-C levels. Patients with lower LDL-C levels at admission have a reduction of aorta-related death in the follow-up period. Statin therapy also was associated with a lower incidence of ARAE in follow-up. These findings suggest that statins might be crucial in improving long-term outcomes in this patient population. Long-term statin therapy administered to patients with acute type B aortic dissection (ATBAD) following thoracic endovascular aortic repair (TEVAR) demonstrates a substantial reduction in both all-cause and aorta-related mortality. Notably, this therapeutic benefit is most evident in patients presenting with elevated low-density lipoprotein cholesterol (LDL-C) levels at admission. Furthermore, statin therapy is associated with a decreased incidence of aorta-related adverse events during follow-up. These findings underscore the pivotal role of statin therapy in enhancing long-term clinical outcomes for ATBAD patients undergoing TEVAR, thereby contributing to improved patient care and prognosis.

This study aimed to assess survival rates and the causes of both early and late mortality in patients with Stanford type B acute aortic dissection (TBAAD). A retrospective analysis was conducted on all consecutive patients presenting with TBAAD from 2000 to 2018 at a single tertiary care centre. The primary end-point was early (<3 months) and late (>3 months) survival following TBAAD, with causes of both early and late mortality evaluated. A total of 274 patients, with a mean age of 64 ± 13 years, were included. Among these, 155 patients (57%) presented with uncomplicated TBAAD, including 52 (19%) identified as high-risk, and 119 patients (43%) had complicated TBAAD. Early aorta-related mortality occurred in 9 patients (3.3%), all within the complicated TBAAD group. The median follow-up period for the entire cohort was 8.5 years [95% confidence interval (CI) 7.6-11.2]. Long-term survival was significantly higher in patients with uncomplicated TBAAD compared to those with complicated TBAAD (P < 0.001). Both complicated and high-risk uncomplicated TBAAD cases required significantly more interventions in the chronic phase (>3 months) compared to uncomplicated TBAAD cases [hazard ratio (HR) 9.8, 95% CI 6.4-15.4, P < 0.001; HR 3.3, 95% CI 2.1-5.1, P < 0.001). Complicated TBAAD presents the greatest risk for aorta-related mortality and interventions. Patients with high-risk uncomplicated TBAAD are also notable for an increased rate of aorta-related mortality and interventions. Thorough evaluation of clinical and anatomical characteristics is essential for determining the optimal therapeutic approach.

National trends in the utilization and timing of TEVAR after Type B aortic dissection

Introduction: Thoracic endovascular aortic repair (TEVAR) has emerged as a promising treatment option for patients with type B aortic dissection (TBAD). However, there is a lack of evidence regarding the long-term morbidity of initial TEVAR compared to optimal medical therapy (OMT) in acute uncomplicated TBAD (uTBAD). Objective: To evaluate real-world data(RWD) on the long-term outcome of Japanese patients with acute uTBAD using a nationwide claims database. Methods: This retrospective cohort study utilizes JMDC, a nationwide claims database under Japan's universal healthcare system. We included patients who were initially hospitalized with a diagnosis of acute TBAD. We defined acute uTBAD by excluding those who died within one month, suffered aortic rupture, traumatic thoracic aortic injury, underwent open-chest surgery, experienced stroke or paralysis, or had less than six months of history in the JMDC. Patients who underwent TEVAR within three months of the index hospitalization (TEVAR group) were compared with those who received optimal medical therapy (OMT group). Propensity score (PS) matching was performed based on age, sex, and year of hospitalization. Using the Kaplan-Meier method, we calculated the cumulative rate of all-cause mortality and aorta-related events. Results: Of 18,445 patients diagnosed with aortic disease between January 2005 and December 2020, 641 were included in the study (OMT group: n=580, TEVAR group: n=61). After PS-matching, demographics of the groups (OMT_PSM: n=183 vs. TEVAR_PSM: n=61) were female (12.6% vs. 13.1%), median age (54 years [IQR, 48-60] vs. 54 years [IQR, 50-61]) and follow-up time (18 months [8-32] vs. 19 months [9-32]), respectively. Kaplan-Meier curves for the aortic-related events (Figure1, 2) are shown as long-term outcomes. Conclusions: This study successfully demonstrated that the estimated 5-year aortic-related event rate in acute uTBAD patients undergoing OMT is approximately 20%, demonstrating the relevance of the RWD source. However, the number of death events in the TEVAR and OMT groups was not sufficient to provide statistical power. Therefore, further studies are warranted to evaluate the long-term prognosis of initial TEVAR for uTBAD.

Background: Type B aortic dissections (TBAD) develop from a tear in the intimal layer of the aorta, distal to the left subclavian artery. This tear separates the aorta into true (TL) and false lumens (FL), increasing the risk of dilation and rupture. In cases of surgical intervention, treatment for type B aortic dissections (TBAD) after the acute phase (&gt; 14 days) is associated with worse outcomes. Identification of those patients who will experience aortic growth could identify patients who would benefit from early intervention. This study aims to characterize blood flow for risk stratification using 4D flow MRI. We identified possible markers of interest: entry tear velocity, pulse wave velocity (PWV), and wall shear stress (WSS). Methods: TBAD patients (n = 7; 3 F) from Emory University Hospital were enrolled. We acquired 4D flow MRI during the acute phase (3T Prisma Fit; Siemens Healthcare). We created image-derived 3D models of lumens and measured velocity at entry tears. We estimated PWV using cross correlation of waveforms at perpendicular, evenly-spaced planes throughout the true lumens. We estimated WSS throughout the false lumen using a previously developed method (Matlab, Ansys EnSight). Growth rates were measured from at follow up computed tomography exams. Results: Three of the patients (P2, P3, P7) did not grow, while P1, P4-P6 grew 2.1, 1.2, 5.3, and 2 mm/month, respectively. Peak entry tear velocities were higher in growth (143 cm/s) than non-growth (90 cm/s) cases, with P5 having the highest (180 cm/s). Forward flow was greatest in the distal end of FL near visceral branches (growth = 17.1, non-growth = 11.0 ml/cycle). Pulse wave velocity measurements between growth and non-growth were similar (4.5 and 3.5 m/s). Both averages were lower than PWV for non-dissected aortas. Regions of high vorticity and WSS can be observed in the true and FL near tears, but no trends were found between growth and non-growth cases. Conclusion: We anticipate stronger trends as enrollment continues, but our preliminary findings demonstrate the first MRI study to enroll acute TBAD subjects and identify markers of interest. Sources of Funding: This study is supported by NIH R01HL155537 and the National Center for Advancing Translational Sciences under Award Numbers UL1TR002378 and TL1R002382.

Currently, evidence concerning the link between maximal aortic diameter and in-hospital mortality in cases of acute type B aortic dissection (ATBAD) is insufficient. Thus, this study aimed to explore the relationship between the maximal aortic diameter at the time of admission and the early prognosis of patients diagnosed with ATBAD. A total of 678 patients with ATBAD were included between January 2016 and December 2018, during which their clinical data was gathered. The independent variable analyzed was the maximal diameter of the aorta, while the dependent variable was mortality during hospitalization. Factors considered in this analysis included the patients’ age, gender, body mass index (BMI), medical history of hypertension, stroke, diabetes, atherosclerosis, smoking habits, chronic kidney insufficiency, time until presentation, systolic and diastolic blood pressures, ejection fraction, presence of aortic regurgitation, symptoms, involvement of abdominal vessels, laboratory findings, and treatment approaches. Of these patients collected, the mean age was 56.03 ± 12.22 years, and approximately 82.45% of them were male. After analysis, it was found that the maximal aortic diameter of patients with ATBAD was positively correlated with in-hospital mortality (OR = 1.06, 95% CI 1.03 to 1.10). Surprisingly, a J curve relationship was detected between maximal aortic diameter (point 31 mm) and in-hospital death for patients with ATBAD. The effect sizes and confidence intervals of the right (maximal aortic diameter > 31 mm) and left (maximal aortic diameter ≤ 31 mm) aspects of the inflection point were 1.06 (1.02–1.11) and 1.03 (0.83–1.28), respectively. In addition, the stratified analysis showed a stable relationship between maximal aortic diameter and in-hospital mortality, while there was no significant difference in the interaction between different subgroups. In patients with ATBAD, a J-curve relationship was identified between the maximal aortic diameter and in-hospital mortality. Specifically, when the maximal aortic diameter exceeds 31 mm, a positive correlation with in-hospital death was observed.

To evaluate the long-term outcomes of the provisional extension to induce complete attachment technique (PETTICOAT) for the treatment of acute and subacute complicated type B aortic dissection (TBAD). We retrospectively collected and analyzed the clinical data of patients with acute and subacute TBAD who were treated using the PETTICOAT technique at our center between March 2014 and March 2023. The primary endpoint was all-cause mortality; secondary endpoints were a composite of complications, such as entry flow, stent-graft-induced new entry (SINE), and re-intervention. The technical success was 92% (46/50). The perioperative mortality was 2% (1/50), and the procedure-related re-intervention was also 2% (1/50). The mean follow-up time was (74.9±33.9) months. The mortality was 4.1% (2/49). The incidence of aortic-related complications was 8.2% (4/49), including new entry flow, 2 retrograde type A aortic dissections, and 1 distal stent graft-induced new entry SINE. The procedure-related re-intervention rate was 4.1% (2/49). After 5 years of follow-up, the total aortic diameter at the renal artery level was reduced from that at the third year of follow-up but was still significantly larger than preoperatively (26.9±6.6 mm vs. 24.1±4.2 mm, p=0.013). While at the covered stent, bare stent, stentless, and celiac artery (CA) levels, the total aortic diameters did not change significantly compared with preoperative values, whereas true lumen (TL) diameters and TL ratios were maintained at obviously higher levels than preoperative. The rate of complete thrombosis of false lumen in the thoracic aortic segment was significantly higher than that in the abdominal aortic segment (79.6% vs 30.6%, p=0.0001). The results indicated that the PETTICOAT technique is safe and effective and could promote positive remodeling of the aorta from the level of the covered stent to the CA. Remodeling of the distal abdominal aorta may fluctuate and requires close follow-up review. The long-term results from our center suggest that the PETTICOAT technique promotes positive remodeling of the aorta from the level of the covered stent to the CA; whereas this advantage does not seem to be significant in the more distal segment of the abdominal aorta, mainly at the level of RA and distal. Therefore, further procedures may be required for aortic dissection of the abdominal segment. In addition, aortic remodeling may fluctuate to some extent during the follow-up period, especially in the abdominal visceral region, so close follow-up review is quite important, and prompt re-intervention is required if necessary.

This study aimed to evaluate the safety and necessity of antithrombotic drugs for acute type B aortic dissection (TBAD) treated with thoracic endovascular aortic repair (TEVAR).The patients of acute TBAD treated with TEVAR were retrospectively enrolled from January 2007 to October 2022 in General Hospital of Northern Theater Command. The primary outcomes such as mortality and aortic adverse events [stroke, paraplegia, limb ischemia, organ failure (renal and intestinal tract), endoleak, redissection, aortic rupture, reintervention, and mortality] were recorded and evaluated at 1 month (early term) and 18 months (late term).The 697 patients of TBAD treated with TEVAR were divided into the antithrombotic (AT) group (n = 208) and nonantithrombotic (NAT) group (n = 489). The incidence of early mortality, early aortic adverse events, and the 18 months of cumulative freedom from all-cause mortality and aortic adverse events were not significantly different between the AT and NAT groups (2.4% versus 1.4%, 2.9% versus 4.5%, 94.7% versus 96.5% and 88.4% versus 89.9%, respectively). Log-rank tests also indicated that there were no significant differences. In multivariate Cox regression models, only pleural effusion, partially thrombosed of false lumen, maximum diameter of false lumen, and branch involvement were independent predictors of mortality, whereas the systolic blood pressure (SBP), pleural effusion, partially thrombosed of false lumen, true lumen compression, maximum diameter of false lumen, branch involvement were independent predictors of adverse aortic events.The antithrombotic drug for acute TBAD treated with TEVAR does not influence the mortality and aortic events in the early and late terms.

BackgroundStanford type B-acute aortic dissection (type B-AAD) is often life-threatening without invasive surgery. Multilineage-differentiating stress enduring cell (Muse cells), which comprise several percent of mesenchymal stem cells (MSCs), are endogenous pluripotent-like stem cells that selectively home to damaged tissue and replace damaged/apoptotic cells by in-vivo differentiation.MethodsMortality, aortic diameter expansion, cell localization, cell differentiation, and inflammation of the dissected aorta were evaluated in type B-AAD model mice intravenously injected with human-Muse cells, -elastin-knockdown (KD)-Muse cells, -human leukocyte antigen-G (HLA-G)-KD-Muse cells, or MSCs, all without immunosuppressant.ResultsHere, we show the Muse (50,000 cells) group has a lower incidence of aortic rupture and mortality of AAD compared with the MSC-50K (50,000 human-MSCs) and vehicle groups. Spectrum computed tomography in-vivo dynamics and 3-dimensional histologic analyses demonstrate that Muse cells more effectively home to the AAD tissue and survive for 8 weeks in the Muse group than in the MSC-750K (750,000 human-MSCs containing 50,000 Muse cells) group. Homing of Muse cells is impeded in the HLA-G-KD-Muse (50,000 cells) group. Differentiation of homed Muse cells into CD31(+) and alpha-smooth muscle actin (+) cells, production and reorganization of elastic fibers in the AAD tissue, and suppression of diameter expansion are greater in the Muse group than in the MSC-750K and elastin-KD-Muse (50,000 cells) groups.ConclusionsIntravenously administered Muse cells reconstruct the dissected aorta and improve mortality and diameter enlargement rates. Moreover, small doses of purified Muse cells are more effective than large doses of MSCs. HLA-G is suggested to contribute to the successful survival and homing of Muse cells.

Stent-assisted, balloon-induced intimal disruption and relamination of aortic dissection (STABILISE) is an extended downstream endovascular management technique for acute type B aortic dissection (TBAD), that aimed to achieve complete aortic remodeling. This systematic review aimed to assess the early and mid-term clinical outcomes with STABILISE in the management of TBAD. A literature search was performed on the Medline, Web of Science, Scopus, and SciELO databases, which returned 195 studies. Five studies were included. Data were extracted using predefined forms. In total, one hundred patients with acute or subacute TBAD managed with STABILISE were included. All studies reported a technical success of 100%. Thirty-day mortality was estimated at 4% (4/100) with no further deaths documented during an estimated mean follow-up of 12.7 months (range 12-15 months). Five percent developed spinal cord ischemia and another 5% developed visceral artery occlusions. One case of aortic rupture during time of balloon inflation was reported. Rare complications included delayed retrograde dissection (1%), aortobronchial fistula (1%), and renal failure (1%). One case of disconnection between stent-graft and bare stent was documented. Six percent of patients developed endoleak, predominately type I. Overall re-intervention rate was 21%, as reported in all studies. Complete obliteration of the false lumen in the thoracic aorta was achieved in 99% of patients and in the abdominal aorta in 96% of patients. STABILISE technique carries promising early and mid-term outcomes with high technical success and low mortality and morbidity. Excellent results on complete false lumen obliteration were observed. However, the heterogeneity among available studies' methodology does not permit firm conclusions, and further prospective analyses are needed to study the long-term outcomes of STABILISE.

Variability in the Treatment of High-Risk Type B Aortic Dissection at a Single Center