Objective assessment of current stent grafts: which graft for which lesion. Ludovic Canaud, MD, PhD Pierre Alric, MD, PhD Montpellier, France
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1 Objective assessment of current stent grafts: which graft for which lesion Ludovic Canaud, MD, PhD Pierre Alric, MD, PhD Montpellier, France
2 Conflict of interest: none 1
3 Introduction Different diseases Different localizations: Aortic arch Descending thoracic aorta Recent evolution of available thoracic stent-grafts 2
4 Thoracic stent-grafts Available devices Selection criteria Strategy 3
5 Available devices 1. Conformable Tag Gore 2. Zenith TX2 proform Cook 3. Valiant Captivia Medtronic 4. Relay Bolton medical 4
6 Conformable Tag Gore Nitinol stent framework /PTFE Diameter: mm Sheath Fr 5
7 Zenith TX2 proform Cook Selfexpanding stainless steel Gianturco Z-stents Dacron 2 Modules Anchorage: hooks Proximal edge Diameter: mm Sheath Fr Distal edge 6
8 Valiant Captivia Medtronic Nitinol stent framework / Polyester graft Diameter: mm Sheath Fr 7
9 Relay Bolton medical Nitinol Stent framework Polyester graft Diameter: mm Sheath Fr 8
10 Relay Bolton Medical Relay NBS Plus 9
11 Thoracic stent-grafts Available devices Selection criteria Strategy 10
12 According to the features of the available stent-grafts Iliofemoral access: Smallest sheath Gore 18 FR Aortic neck Small aortic neck: Gore C TAG 21 mm Aortic neck 16 mm 11
13 According to the features of the available stent-grafts Conformability Type I endoleak Dake Radiology 2010 Collapse Canaud JTCS 2010 Migration 12
14 According to the features of the available stent-grafts Conformability: Experimental study Valiant Excessive oversizing: negative impact To secure proximal anchorage Radial force Presence of a proximal open stent segment Canaud L, Alric P, Laurent M, Baum TP, Branchereau P, Marty-Ané CH, Berthet JP. Proximal fixation of thoracic stent-grafts.. JEVT
15 According to the features of the available stent-grafts Conformability: Experimental study Valiant: up to C-TAG: up to p =.001 Relay: up to Zenith Pro-Form : up to Canaud L, Cathala P, Joyeux F, Branchereau P, Marty-Ané C, Alric P Improvement in conformability of the latest generation of thoracic stent grafts. JVS
16 According to the features of the available stent-grafts Accuracy of the delivery system Proximal: Valiant / Zenith / Relay 15
17 According to the features of the available stent-grafts Accuracy of the delivery system Distal: Celiac trunk: Zenith 16
18 According to the features of the available stent-grafts Retrograde aortic dissection MOTHER database and systematic review: n=9594 Incidence of RTAD was not significantly different: p=.49 With proximal bare stent (2.8%) Non-bare stent (2.4%) Canaud L, Ozdemir BA, Patterson B, Holt P, Loftus I, Thompson M. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg
19 According to the features of the available stent-grafts Distale Bare stenting for aortic dissection: n 108 False-lumen patency: Acute: complete reattachment Chronic: failed to supress completely Reintervention rate: 16.6% Device failure rate: 9.2% Canaud L, Patterson BO, Peach G, Hinchliffe R, Loftus I, Thompson MM. Systematic review of outcomes of combined proximal stent grafting with distal bare stenting for management of aortic dissection. JTCS
20 According to the features of the available stent-grafts Distale Bare stenting for aortic dissection Stenosis of the visceral arteries Supplied by the false lumen: 54.5% Supplied by the true lumen: 7.9% Faure E, Canaud L, Cathala P, Serres I, Marty-Ané CH, Alric P.. Assessment of abdominal branch vessel patency after bare-metal stenting of the thoracoabdominal aorta in a human ex vivo model of acute type B aortic dissection JVS
21 Thoracic stent-grafts Available devices Selection criteria Strategy 20
22 Strategy: Degenerative aneurysm Descending thoracic aorta Straight neck: all the stent-graft Short distal neck: Zénith Proform 21
23 Strategy: Degenerative aneurysm Aortic arch : > 2cm proximal neck: Conformability C Tag / Valiant Short proximal neck: Accuracy / Conformability Valiant Captivia Aortic valve Proximal tip C Tag 22
24 Strategy Traumatic rupture : Small aorta Short proximal neck Accuracy / Conformability Type B dissection: Risk of RTAD Short proximal neck Accuracy / Conformability C Tag Valiant Captivia (22 mm) C Tag Valiant Captivia 23
25 Results 48 patients: traumatic rupture First-generation thoracic stent-grafts: 32 Second-generation thoracic stent-grafts: 15 Decreased stent-graft related morbidity: 18.7% to 6.2% p= Canaud L, Joyeux F, Berthet JP, Hireche K, Marty-Ané C, Alric P. Impact of stent-graft development on outcome of endovascular repair of acute traumatic transection of the thoracic aorta. JEVT
26 Conclusion
27 Stent-grafts have different features Size des endoprothèse Conformability Accuracy Parietal stress Knowledge of stent-graft features and personal experience: to guide the choice 26
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