Spot-stent grafting revisited - mid-term results of the treatment of Stanford type B aortic dissection and intramural haematoma.

Abstract

Background: Spot-stent grafting (SSG) for acute/subacute Stanford type B aortic dissection (ADB) and intramural hematoma (IMHB) entails selective coverage of the primary tear in the distal thoracic aorta (zones 4 or 5), with the stent graft fully deployed within the dissected segment-an intentional use beyond the Instructions for Use (IFU) aimed at minimising aortic coverage and preserving spinal cord perfusion. While early outcomes were favourable, long-term data on durability and reintervention remain limited. Materials and methods: In a single-centre retrospective analysis, all patients with acute/subacute ADB or IMHB treated with SSG between 03/1997 and 08/2024 were evaluated. The primary endpoint was the cumulative incidence of reintervention using a competing risk model over a median follow-up of 6.9 years (range 1.7 months-16.9 years). Secondary endpoints included technical success, aortic remodeling (AR), and false lumen thrombosis (FLT). Results: Of 270 TEVAR-treated patients with ADB or IMHB, 30 (16 ADB, 14 IMHB) underwent SSG. The cumulative incidence of reintervention at 30 days, one year, and three years was 6.7%, 16.7%, and 20%, respectively. Technical success was 100% with no 30-day mortality, stroke, or spinal ischaemia. Limited FLT occurred in 29/30, complete AR in 22/30. Reinterventions (7/30-23.3%) were distal (4) or proximal (3) extensions. Six-year survival was 66.7%. Conclusions: SSG demonstrated perioperative safety and mid-term efficacy beyond the IFU. However, higher reintervention rates - mainly proximal or distal extensions - may be expected, reflecting a trade-off for enhanced spinal cord protection in distal thoracic lesions when applied in carefully selected patients.