Aortic remodeling after thoracic endovascular repair combined with anti-thrombotic therapy for acute type B aortic dissection

To investigate the effect of anti-thrombotic (AT) drugs on aortic remodeling and clinical prognosis after thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (TBAD). This retrospective observational study included consecutive patients with acute TBAD who underwent TEVAR and underwent computed tomography angiography (CTA) preoperatively and during follow-up between January 2012 and September 2023 at the General Hospital of Northern Theater Command. Based on whether AT therapy was administered, the patients were divided into the AT group (patients receiving AT drugs) and the NAT group (patients not receiving AT drugs). Image data were analyzed for the thrombosis status of the false lumen (FL), as well as changes in the maximum diameter of the true lumen (TL), FL, and transaortic lumen (TAL) in the stented thoracic aorta (STA), unstented thoracic aorta (UTA), and abdominal aorta (AA). 12 - month clinical outcomes (major adverse event) were also recorded. A total of 175 patients with acute TBAD were included in this study. The preoperative FL status of patent, partial thrombosis, and complete thrombosis, respectively, in the STA, UTA, and AA showed no significant differences between the AT and NAT groups. The preoperative mean inner diameters of TL, FL, and TAL, respectively, in the STA, UTA, and AA were also not significantly different between the two groups. Similar to the aforementioned in the preoperative, there were also no significant differences between the two groups at the 12-month follow-up. At 12-month follow-up, FL status (patent vs. completely thrombosed) showed significantly favorable changes compared with preoperative images in the STA, UTA, and AA segments (all P < 0.001). In both the AT and NAT groups, changes in the maximum diameter of TL, FL, and TAL in all segments were statistically significant at 12-month follow-up (all P < 0.001). Regarding diameter changes: TAL expansion was 4.0%, 14.9%, and 53.7% in the STA, UTA, and AA, respectively; TAL stabilization was 62.3%, 36.6%, and 44.6% in the STA, UTA, and AA, respectively; and TAL shrinkage was 33.7%, 48.6%, and 1.7% in the STA, UTA, and AA, respectively. During a 12-month follow-up, 13 patients (7.4%) had a major adverse event. Moreover, the difference between the two groups was not statistically significant (P > 0.05). Among acute TBAD patients who underwent TEVAR, at the 12 - month follow-up, patients receiving AT drugs had a comparable prognosis in aortic remodeling to those not receiving AT drugs.