Preemptive TEVAR after type I aortic dissection repair: the ERADICARE trial on aortic remodeling and one-year outcomes

A persistent distal false lumen after surgery for DeBakey type I acute aortic dissection (AAD) is associated with increased risk of adverse aortic events (AAEs). This pilot randomized controlled trial aimed to evaluate whether elective thoracic endovascular aortic repair (TEVAR), performed 1–3 months after type I AAD surgery in selected high-risk patients, promotes aortic remodeling and improves clinical outcomes. Thirty-two patients who underwent surgical repair for type I AAD were randomized to either elective TEVAR (n = 15) or standard conservative management (n = 17). CT angiography–based inclusion criteria were: (a) a re-entry tear in Ishimaru zones 3 or 4, and (b) a maximum descending thoracic aorta (DTA) diameter > 40 mm and/or a false lumen diameter > 20 mm. One-year follow-up included clinical assessment and CT angiography. The TEVAR group exhibited significantly more favorable aortic remodeling than the conservative group, as demonstrated by greater reductions in total aortic diameter (zones 2–9), greater increases in true lumen diameter (zones 3–8), and greater reductions in false lumen diameter (zones 2–8). Complete false lumen thrombosis was also more frequent in the TEVAR group (zones 2–6). Clinically, the TEVAR group had significantly lower rates of dissection extension (0% vs. 29.4%; p = 0.050), rehospitalization due to complications (0% vs. 58.8%; p < 0.001), and long-term AAEs (20.0% vs. 58.8%; p = 0.026). In selected high-risk patients, performing TEVAR 1–3 months after surgical repair of type I AAD may promote favorable aortic remodeling and be associated with improved one-year clinical outcomes. This study is registered with ISRCTN under the title “Endovascular Repair After Aortic Dissection Type I or Conservative – Aortic Remodeling Enhancement (ERADICARE Trial),” registration number ISRCTN 11,964,494 (https://doi.org/10.1186/ISRCTN11964494).