Optimal timing of thoracic endovascular aortic repair for subacute and chronic type B aortic dissection: insights from the Tokushukai Medical Database†.

OBJECTIVES

This study aimed to evaluate the impact of intervention timing on thoracic aortic remodelling following thoracic endovascular aortic repair (TEVAR) for subacute and chronic type B aortic dissection (TBAD).

METHODS

The study included 110 patients undergoing TEVAR for TBAD at least 2 weeks after onset, sourced from the Tokushukai Medical Database. The primary outcome was complete thoracic aortic remodelling (CTR) at 1 year, defined as thoracic false lumen thrombosis and a false lumen diameter <10 mm up to the level of Th10.

RESULTS

The 1-year CTR rate was 67.3%. CTR was strongly associated with intervention timing: 88.4% (≤3 months: n = 69), 57.1% (3-12 months: n = 14) and 18.5% (≥12 months: n = 27). Receiver operating characteristic (ROC) curve analysis confirmed a 3-month cutoff for achieving CTR (area under the curve 0.857). Multivariable analysis identified interval from onset to TEVAR >3 months (odds ratio [OR] 9.75, 95% confidence interval [CI] 2.86-33.28) and initial thoracic false lumen diameter (OR 1.13, 95% CI 1.02-1.27) as independent predictors of CTR failure. Similar trends were observed in the DeBakey IIIb subgroup, with a 3-month cutoff for achieving CTR and interval from onset to TEVAR >3 months (OR 16.38, 95% CI 3.54-75.83), initial thoracic false lumen diameter (OR 1.25, 95% CI 1.00-1.54) and initial abdominal aortic diameters (OR 1.14, 95% CI 1.01-1.29) predicting CTR failure.

CONCLUSIONS

Early TEVAR within 3 months of onset is crucial for achieving complete aortic remodelling in TBAD. Therefore, early preventive TEVAR in eligible patients is recommended to optimize outcomes.