Early Prediction of Distal Stent Graft-Induced New Entry after Thoracic Endovascular Aortic Repair with Computational Fluid Dynamics

Distal stent graft-induced new entry (dSINE) is a serious complication that often arises after Thoracic Endovascular Aortic Repair (TEVAR) for Stanford type B aortic dissection (TBAD), posing significant life-threatening risks. Early prediction and timely intervention of dSINE are therefore critical. This study included 20 TBAD patients who underwent TEVAR, of whom 10 developed dSINE postoperatively, while the other 10 did not. Computational fluid dynamics (CFD) was utilized to simulate the hemodynamic conditions, and various hemodynamic parameters were obtained in the short term after the intervention, including blood flow velocity, wall pressure, peak wall shear stress (Peak WSS), time-averaged wall shear stress (TAWSS), normalized transverse wall shear stress (NtransWSS), oscillatory shear index (OSI), and relative residence time (RRT). The overall hemodynamic profiles were compared between the two groups, and local hemodynamic conditions were analyzed in three specific zones: the aortic zone covered by the stent, the 2 cm-long aortic zone adjacent to the distal landing stent, and the level of the distal landing zone of the stent. The results indicated that local hemodynamic parameters, including velocity, Peak WSS, TAWSS, NtransWSS, OSI, and RRT, might serve as potential early predictive indicators of dSINE. These findings may contribute to the early prevention of dSINE, assisting clinicians in decision-making and optimizing risk stratification strategies.