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TEVAR associated with increase in pulsatile longitudinal, circumferential strains
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In patients with thoracic aortic aneurysm, thoracic endovascular aortic repair with current thoracic stent grafts is associated with an increase in pulsatile longitudinal strains in the aortic arch and pulsatile circumferential strains at the level of the celiac trunk, according to recent findings.
In the retrospective study, researchers assessed eight patients (mean age, 71 ± 8.2 years; six men) who underwent imaging of pulsatile aortic strains through custom-developed software and cardiac-gated CT performed before TEVAR and during a median follow-up of 0.1 months (interquartile range, 0.1-5.8). The testing measured lengths of the ascending aorta, the aortic arch and the descending aorta, and the researchers computed diameters and areas at the sinotubular junction. They quantified pulsatile longitudinal and circumferential strains as systolic increments of length and circumference divided by the corresponding diastolic values.
The median interval from treatment to post-TEVAR imaging was 0.1 months (interquartile range, 0.1-5.8). A homogeneity was seen in patients regarding maximum aneurysm size (57.1 ± 13.1 mm; coefficient of variation [CV] = 0.24); proximal neck size (38.1± 2.6 mm; CV = 0.07); proximal stent-graft oversizing (15.4 ± 7%; CV = 0.45); distal neck size (31.4 ± 2.7 mm; CV = 0.08); distal stent-graft oversizing (22.6 ± 11.7%; CV = 0.52); and in situ stent-graft length (161.5 ± 70.2 mm, CV = 0.43), the researchers wrote.
The average pulsatile longitudinal strain ranged from 1.4% to 7.1% and was highest in the aortic arch (P < .001) and increased by 77% in the arch post-TEVAR (from 7.1 ± 2.5% to 12.5 ± 5.1%; P = .04) and by 69% in the ascending aorta (5.6 ± 2.3% vs. 9.4 ± 4.4%; P = .006). The average range of circumferential strain was from 3.6% to 5% pre-TEVAR and showed no significant difference throughout the thoracic aorta. A nonsignificant post-TEVAR increase was seen at the unstented sinotubular junction (5 ± 1.4% to 6.3 ± 1%; P = .18), whereas the celiac trunk demonstrated a significant increase (3.6 ± 1.8% to 6.2 ± 1.8%; P = .02). Image artifacts rendered pulsatile circumferential strains within stented segments unreliable, the researchers wrote.
“This dynamic imaging study in [thoracic aortic aneurysm] patients managed with TEVAR showed that current thoracic stent grafts are associated with an increase in pulsatile longitudinal strains in the aortic arch, and pulsatile circumferential strains at the level of the celiac trunk,” they wrote. “These data may yield insight into the pathogenesis of TEVAR-related complications, such as retrograde or antegrade dissection, aneurysm formation, and rupture, and might imply the need for more compliant stent-graft designs.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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