Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection
The precise sizing of the stent graft in thoracic endovascular aortic repair (TEVAR) affects aortic remodeling and hence, further outcome. Covering the proximal entry tear is essential for successful treatment of Type B aortic dissection. Intravascular ultrasound (IVUS) enables real-time aortic diam...
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| description | The precise sizing of the stent graft in thoracic endovascular aortic repair (TEVAR) affects aortic remodeling and hence, further outcome. Covering the proximal entry tear is essential for successful treatment of Type B aortic dissection. Intravascular ultrasound (IVUS) enables real-time aortic diameter assessment, and is especially useful when computed tomography (CT) image quality is poor. IVUS, however, is not routinely utilized due to cost inefficiency. We investigated the impact of IVUS-assisted stent graft sizing on aortic remodeling in TEVAR. In this single-center retrospective study we evaluated patients with Type B aortic dissection undergoing both CT and IVUS before TEVAR. We assessed the aortic diameter at the level of the left subclavian artery via both methods before stent implantation and analyzed due to which method the implanted stent graft was chosen, retrospectively. To determine the degrees of aortic remodeling involved, we evaluated true lumen and false lumen diameters, and total aortic remodeling in CT. We analyzed 45 patients with Type B aortic dissection undergoing TEVAR. The mean ages were 66.9±10.0 years fo0072 IVUS (n = 20) and 62.3±14.2 years for CT-assisted TEVAR (n = 25; p = 0.226). The follow-up time for both groups did not differ between the two groups (IVUS: 22.9±23.1 months, CT: 25.6±23.0 months; p = 0.700). While both methods were associated with advantages regarding aortic remodeling, IVUS-assisted sizing yielded a greater increase in true lumen (30.4±6.2 vs. 25.6±5.3; p = 0.008) and reductions in false lumen (14.4±8.5 vs. 23.9±9.3; p = 0.001) and total aortic diameter (35.5±6.0 vs. 39.9±8.1; p = 0.045). IVUS-guided stent graft sizing in Type B aortic dissection shows beneficial effects on aortic remodeling and might be of additional advantage in aortic diseases, especially when CT image quality is poor. |
| doi_str_mv | 10.1371/journal.pone.0196180 |
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Covering the proximal entry tear is essential for successful treatment of Type B aortic dissection. Intravascular ultrasound (IVUS) enables real-time aortic diameter assessment, and is especially useful when computed tomography (CT) image quality is poor. IVUS, however, is not routinely utilized due to cost inefficiency. We investigated the impact of IVUS-assisted stent graft sizing on aortic remodeling in TEVAR. In this single-center retrospective study we evaluated patients with Type B aortic dissection undergoing both CT and IVUS before TEVAR. We assessed the aortic diameter at the level of the left subclavian artery via both methods before stent implantation and analyzed due to which method the implanted stent graft was chosen, retrospectively. To determine the degrees of aortic remodeling involved, we evaluated true lumen and false lumen diameters, and total aortic remodeling in CT. We analyzed 45 patients with Type B aortic dissection undergoing TEVAR. The mean ages were 66.9±10.0 years fo0072 IVUS (n = 20) and 62.3±14.2 years for CT-assisted TEVAR (n = 25; p = 0.226). The follow-up time for both groups did not differ between the two groups (IVUS: 22.9±23.1 months, CT: 25.6±23.0 months; p = 0.700). While both methods were associated with advantages regarding aortic remodeling, IVUS-assisted sizing yielded a greater increase in true lumen (30.4±6.2 vs. 25.6±5.3; p = 0.008) and reductions in false lumen (14.4±8.5 vs. 23.9±9.3; p = 0.001) and total aortic diameter (35.5±6.0 vs. 39.9±8.1; p = 0.045). IVUS-guided stent graft sizing in Type B aortic dissection shows beneficial effects on aortic remodeling and might be of additional advantage in aortic diseases, especially when CT image quality is poor.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0196180</identifier><identifier>PMID: 29672613</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aneurysm, Dissecting - diagnosis ; Aneurysm, Dissecting - therapy ; Aneurysms ; Aorta ; Aorta, Thoracic - diagnostic imaging ; Aorta, Thoracic - pathology ; Aortic dissection ; Aortography ; Biology and Life Sciences ; Cardiology ; Cardiovascular surgery ; Cardiovascular system ; Care and treatment ; Computed tomography ; Development and progression ; Dissection ; Endovascular Procedures - methods ; Female ; Grafting ; Heart surgery ; Hemodynamics ; Humans ; Image quality ; Implantation ; Implants ; Male ; Medical imaging ; Medicine ; Medicine and Health Sciences ; Methods ; Middle Aged ; Patient outcomes ; Patients ; Prospective Studies ; Research and Analysis Methods ; Sizing ; Surgical implants ; Tearing ; Technology application ; Thorax ; Tomography, X-Ray Computed ; Ultrasonic imaging ; Ultrasonography ; Ultrasound ; Ultrasound imaging ; Vascular Remodeling</subject><ispartof>PloS one, 2018-04, Vol.13 (4), p.e0196180-e0196180</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Lortz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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The mean ages were 66.9±10.0 years fo0072 IVUS (n = 20) and 62.3±14.2 years for CT-assisted TEVAR (n = 25; p = 0.226). The follow-up time for both groups did not differ between the two groups (IVUS: 22.9±23.1 months, CT: 25.6±23.0 months; p = 0.700). While both methods were associated with advantages regarding aortic remodeling, IVUS-assisted sizing yielded a greater increase in true lumen (30.4±6.2 vs. 25.6±5.3; p = 0.008) and reductions in false lumen (14.4±8.5 vs. 23.9±9.3; p = 0.001) and total aortic diameter (35.5±6.0 vs. 39.9±8.1; p = 0.045). IVUS-guided stent graft sizing in Type B aortic dissection shows beneficial effects on aortic remodeling and might be of additional advantage in aortic diseases, especially when CT image quality is poor.</description><subject>Aged</subject><subject>Aneurysm, Dissecting - diagnosis</subject><subject>Aneurysm, Dissecting - therapy</subject><subject>Aneurysms</subject><subject>Aorta</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Aorta, Thoracic - pathology</subject><subject>Aortic dissection</subject><subject>Aortography</subject><subject>Biology and Life Sciences</subject><subject>Cardiology</subject><subject>Cardiovascular surgery</subject><subject>Cardiovascular system</subject><subject>Care and treatment</subject><subject>Computed tomography</subject><subject>Development and progression</subject><subject>Dissection</subject><subject>Endovascular Procedures - methods</subject><subject>Female</subject><subject>Grafting</subject><subject>Heart surgery</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Image quality</subject><subject>Implantation</subject><subject>Implants</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Research and Analysis Methods</subject><subject>Sizing</subject><subject>Surgical implants</subject><subject>Tearing</subject><subject>Technology application</subject><subject>Thorax</subject><subject>Tomography, X-Ray Computed</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography</subject><subject>Ultrasound</subject><subject>Ultrasound imaging</subject><subject>Vascular 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ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection</title><author>Lortz, Julia ; Tsagakis, Konstantinos ; Rammos, Christos ; Horacek, Michael ; Schlosser, Thomas ; Jakob, Heinz ; Rassaf, Tienush ; Jánosi, Rolf Alexander</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-79b32d1d2c11a8c4f9555fee37641a7e28246e1eda840d3e6d734b1952eb0f673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Aneurysm, Dissecting - diagnosis</topic><topic>Aneurysm, Dissecting - therapy</topic><topic>Aneurysms</topic><topic>Aorta</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aorta, Thoracic - pathology</topic><topic>Aortic dissection</topic><topic>Aortography</topic><topic>Biology and Life Sciences</topic><topic>Cardiology</topic><topic>Cardiovascular surgery</topic><topic>Cardiovascular 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lortz, Julia</au><au>Tsagakis, Konstantinos</au><au>Rammos, Christos</au><au>Horacek, Michael</au><au>Schlosser, Thomas</au><au>Jakob, Heinz</au><au>Rassaf, Tienush</au><au>Jánosi, Rolf Alexander</au><au>Yu, Jun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-04-19</date><risdate>2018</risdate><volume>13</volume><issue>4</issue><spage>e0196180</spage><epage>e0196180</epage><pages>e0196180-e0196180</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The precise sizing of the stent graft in thoracic endovascular aortic repair (TEVAR) affects aortic remodeling and hence, further outcome. Covering the proximal entry tear is essential for successful treatment of Type B aortic dissection. Intravascular ultrasound (IVUS) enables real-time aortic diameter assessment, and is especially useful when computed tomography (CT) image quality is poor. IVUS, however, is not routinely utilized due to cost inefficiency. We investigated the impact of IVUS-assisted stent graft sizing on aortic remodeling in TEVAR. In this single-center retrospective study we evaluated patients with Type B aortic dissection undergoing both CT and IVUS before TEVAR. We assessed the aortic diameter at the level of the left subclavian artery via both methods before stent implantation and analyzed due to which method the implanted stent graft was chosen, retrospectively. To determine the degrees of aortic remodeling involved, we evaluated true lumen and false lumen diameters, and total aortic remodeling in CT. We analyzed 45 patients with Type B aortic dissection undergoing TEVAR. The mean ages were 66.9±10.0 years fo0072 IVUS (n = 20) and 62.3±14.2 years for CT-assisted TEVAR (n = 25; p = 0.226). The follow-up time for both groups did not differ between the two groups (IVUS: 22.9±23.1 months, CT: 25.6±23.0 months; p = 0.700). While both methods were associated with advantages regarding aortic remodeling, IVUS-assisted sizing yielded a greater increase in true lumen (30.4±6.2 vs. 25.6±5.3; p = 0.008) and reductions in false lumen (14.4±8.5 vs. 23.9±9.3; p = 0.001) and total aortic diameter (35.5±6.0 vs. 39.9±8.1; p = 0.045). IVUS-guided stent graft sizing in Type B aortic dissection shows beneficial effects on aortic remodeling and might be of additional advantage in aortic diseases, especially when CT image quality is poor.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29672613</pmid><doi>10.1371/journal.pone.0196180</doi><tpages>e0196180</tpages><orcidid>https://orcid.org/0000-0002-5798-3728</orcidid><orcidid>https://orcid.org/0000-0002-9966-6886</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2018-04, Vol.13 (4), p.e0196180-e0196180 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2027633393 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Aged Aneurysm, Dissecting - diagnosis Aneurysm, Dissecting - therapy Aneurysms Aorta Aorta, Thoracic - diagnostic imaging Aorta, Thoracic - pathology Aortic dissection Aortography Biology and Life Sciences Cardiology Cardiovascular surgery Cardiovascular system Care and treatment Computed tomography Development and progression Dissection Endovascular Procedures - methods Female Grafting Heart surgery Hemodynamics Humans Image quality Implantation Implants Male Medical imaging Medicine Medicine and Health Sciences Methods Middle Aged Patient outcomes Patients Prospective Studies Research and Analysis Methods Sizing Surgical implants Tearing Technology application Thorax Tomography, X-Ray Computed Ultrasonic imaging Ultrasonography Ultrasound Ultrasound imaging Vascular Remodeling |
| title | Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection |
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