Optimal timing of thoracic endovascular aortic repair for subacute and chronic type B aortic dissection: insights from the Tokushukai Medical Database†.

Objectives: This study aimed to evaluate the impact of intervention timing on thoracic aortic remodelling following thoracic endovascular aortic repair (TEVAR) for subacute and chronic type B aortic dissection (TBAD).

Methods: The study included 110 patients undergoing TEVAR for TBAD at least 2 weeks after onset, sourced from the Tokushukai Medical Database. The primary outcome was complete thoracic aortic remodelling (CTR) at 1 year, defined as thoracic false lumen thrombosis and a false lumen diameter <10 mm up to the level of Th10.

Results: The 1-year CTR rate was 67.3%. CTR was strongly associated with intervention timing: 88.4% (≤3 months: n = 69), 57.1% (3-12 months: n = 14) and 18.5% (≥12 months: n = 27). Receiver operating characteristic (ROC) curve analysis confirmed a 3-month cutoff for achieving CTR (area under the curve 0.857). Multivariable analysis identified interval from onset to TEVAR >3 months (odds ratio [OR] 9.75, 95% confidence interval [CI] 2.86-33.28) and initial thoracic false lumen diameter (OR 1.13, 95% CI 1.02-1.27) as independent predictors of CTR failure. Similar trends were observed in the DeBakey IIIb subgroup, with a 3-month cutoff for achieving CTR and interval from onset to TEVAR >3 months (OR 16.38, 95% CI 3.54-75.83), initial thoracic false lumen diameter (OR 1.25, 95% CI 1.00-1.54) and initial abdominal aortic diameters (OR 1.14, 95% CI 1.01-1.29) predicting CTR failure.

Conclusions: Early TEVAR within 3 months of onset is crucial for achieving complete aortic remodelling in TBAD. Therefore, early preventive TEVAR in eligible patients is recommended to optimize outcomes.