The necessity evaluation of distal bare stent for treating type B aortic dissection using image-based computational flow analysis

This study aims to verify the necessity of the provisional extension to induce complete attachment (PETTICOAT) technique, by comparing the clinical outcomes with traditional thoracic endovascular repair (TEVAR) procedure. 40 patients with a total of 120 computed tomography angiography examinations (including Pre, Post1, and Post2 for each case) were included and divided into PETTICOAT group (n = 20) and TEVAR group (n = 20) according to the employed intervention technique. The potential risk factors for distal stent-induced new entry (SINE) and morphological and hemodynamic indices related to the aortic remodeling were computed and compared between two groups. All computed potential risk factors for distal SINE showed insignificant difference between PETTICOAT and TEVAR groups. There is no statistically significant difference in the morphological parameters when assessing the aortic remodeling. Regarding hemodynamic factors, the percentage of high relative residence time of Post2 was greater in PETTICOAT group than that of TEVAR group (median, 0.22; interquartile range (IQR), [0.00–0.56] in PETTICOAT vs median, 0.01; IQR, [0.00–0.10] in TEVAR; p = 0.01). The first balance position of computed luminal pressure difference shifted more distally from Post1 to Post2 for patients underwent PETTICOAT than those underwent TEVAR (median, 1.04 cm; IQR, [0.00–6.29 cm] in PETTICOAT vs median, 0.00 cm; IQR, [−1.66 to 1.28 cm] in TEVAR; p = 0.02). PETTICOAT procedure could effectively enhance false lumen thrombosis and aortic remodeling when assessed from functional perspective. However, there is a lack of evidence to support that PETTICOAT can prevent distal SINE.