Editor's Choice - Five Year Outcomes of the Fabulous Stent System in the Management of Complicated Type B Aortic Dissection: A Prospective Multicentre Study.

Abstract

This study aimed to assess the five year follow up results from a prospective, single arm, multicentre study evaluating the efficacy of the Fabulous stent system (DiNovA Meditech, Hangzhou, China) in the treatment of complicated Stanford type B aortic dissection (cTBAD). Between December 2017 and October 2019, 144 patients from 14 centres in China were prospectively enrolled. Primary outcomes were freedom from all cause death and long term aortic related adverse events. Secondary five year outcomes were the changes in the false lumen (FL) and true lumen (TL) in the bare stent and distal bare stent segments. The five year freedom from all cause death was 86.6%, and imaging follow up was completed by 64 patients (mean age 54.4 years; 89.1% male). From pre-procedure to the five year follow up there was a consistent increase in the minimum diameter of the TL (13.01 ± 6.52 mm pre-procedure; 23.16 ± 5.37 mm one year follow up; 24.68 ± 5.27 mm five year follow up) and a simultaneous reduction in the maximum diameter of the FL within the bare stent segment (28.69 ± 7.09 mm pre-procedure; 9.08 ± 12.84 mm one year follow up; 7.67 ± 12.51 mm five year follow up). The proportion of patients with complete FL thrombosis in the bare stent segment increased from 64% to 81%. During the five year follow up, three patients developed retrograde type A aortic dissection and three patients underwent a second intervention. Following endovascular treatment using the Fabulous system, the five year cTBAD cohort outcomes demonstrated encouraging results regarding TL expansion and FL thrombosis. These results should enhance the understanding of the application of the Proximal ExTension To Induce COmplete ATtachment (PETTICOAT) technique in cTBAD.