Computational fluid analysis of symptomatic chronic type B aortic dissections managed with the Streamliner Multilayer Flow Modulator.

ABSTRACT

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.