TY - JOUR
T1 - Computational fluid analysis of symptomatic chronic type B aortic dissections managed with the Streamliner Multilayer Flow Modulator
AU - Stefanov, Florian
AU - Sultan, Sherif
AU - Morris, Liam
AU - Elhelali, Ala
AU - Kavanagh, Edel P.
AU - Lundon, Violet
AU - Sultan, Mohamed
AU - Hynes, Niamh
N1 - Publisher Copyright:
© 2016 Society for Vascular Surgery
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Objective Managing symptomatic chronic type B aortic dissection (SCTBAD) by the Streamliner Multilayer Flow Modulator (SMFM) stent (Cardiatis, Isnes, Belgium) is akin to provisional structural support to induce complete attachment of the dissection flap, but with the ability of aortic remolding. This study investigated the SMFM's capability to enact healing of SCTBAD. Methods Clinical data for 12 cases comprising preoperative and postoperative treatment of SCTBAD were obtained from a multicenter database hosted by the Multilayer Flow Modulator Global Registry, Ireland. A biomechanical analysis, by means of computational fluid dynamics modeling, of the hemodynamic effects and branch patency associated with the use of the SMFM was performed for all cases. The mean length of the dissections was 30.23 ± 13.3 cm. There were 30 SMFMs used, which covered 69 aortic branches. Results At 1-year follow-up, the true lumen volume increased from 175.74 ± 98.83 cm3 to 209.87 ± 128.79 cm3; the false lumen decreased from 135.2 ± 92.03 cm3 to 123.19 ± 110.11 cm3. The false lumen index decreased from 0.29 ± 0.13 (preoperatively) to 0.21 ± 0.15 (postoperatively). The primary SMFM treatment of SCTBAD increased carotid perfusion by 35% ± 21% (P =.0216) and suprarenal perfusion by 78% ± 32% (P =.001). The wall pressure distribution blended along the newly enlarged true lumen, whereas the false lumen wall pressure decreased by 6.23% ± 4.81% for the primary group (cases 1-7) and by 3.84% ± 2.59% for the secondary group (cases 8-12). Conclusions SMFM reduces the false lumen wall pressure through flow modulation. It preserves patency of all branches, minimizing the incidence of short-term complications. The SMFM is a valuable option in managing primary SCTBAD, without midterm complications.
AB - Objective Managing symptomatic chronic type B aortic dissection (SCTBAD) by the Streamliner Multilayer Flow Modulator (SMFM) stent (Cardiatis, Isnes, Belgium) is akin to provisional structural support to induce complete attachment of the dissection flap, but with the ability of aortic remolding. This study investigated the SMFM's capability to enact healing of SCTBAD. Methods Clinical data for 12 cases comprising preoperative and postoperative treatment of SCTBAD were obtained from a multicenter database hosted by the Multilayer Flow Modulator Global Registry, Ireland. A biomechanical analysis, by means of computational fluid dynamics modeling, of the hemodynamic effects and branch patency associated with the use of the SMFM was performed for all cases. The mean length of the dissections was 30.23 ± 13.3 cm. There were 30 SMFMs used, which covered 69 aortic branches. Results At 1-year follow-up, the true lumen volume increased from 175.74 ± 98.83 cm3 to 209.87 ± 128.79 cm3; the false lumen decreased from 135.2 ± 92.03 cm3 to 123.19 ± 110.11 cm3. The false lumen index decreased from 0.29 ± 0.13 (preoperatively) to 0.21 ± 0.15 (postoperatively). The primary SMFM treatment of SCTBAD increased carotid perfusion by 35% ± 21% (P =.0216) and suprarenal perfusion by 78% ± 32% (P =.001). The wall pressure distribution blended along the newly enlarged true lumen, whereas the false lumen wall pressure decreased by 6.23% ± 4.81% for the primary group (cases 1-7) and by 3.84% ± 2.59% for the secondary group (cases 8-12). Conclusions SMFM reduces the false lumen wall pressure through flow modulation. It preserves patency of all branches, minimizing the incidence of short-term complications. The SMFM is a valuable option in managing primary SCTBAD, without midterm complications.
UR - http://www.scopus.com/inward/record.url?scp=85007240656&partnerID=8YFLogxK
U2 - 10.1016/j.jvs.2016.07.135
DO - 10.1016/j.jvs.2016.07.135
M3 - Article
C2 - 27889286
AN - SCOPUS:85007240656
SN - 0741-5214
VL - 65
SP - 951
EP - 963
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 4
ER -