TCT-777 The Multilayer Flow Modulator Stent For The Treatment Of Thoraco Abdominal And Abdominal Aortic Aneurysms. Moroccan Experience

Abstract

Background: Thoraco Abdominal Aortic Aneurysms (TAAA) and Abdominal Aortic Aneurysms (AAA) are traditionally treated surgically, but more and more by interventional procedures (endografts, fenestrated, branched grafts, chimney techniques). We used a new concept of stent, the Multilayer Stent Flow Modulator (M.F.M) to treat these aneurysms (A) and try to avoid some major complications. Methods: This selfexpandable M.F.M is a 3 D braided tube made of several interconnected layers without any covering. We will explain and demonstrate the key principles of the stent leading to thrombosis, shrinkage of the A, eliminating the risk of rupture. Moreover, this M.F.M preserves the collateral branches allowing the possibility to cover any artery without compromising the flow (renal, digestive arteries, supra aortic vessels.). Results: 10 TAAA, 8 AAA (7 extended to both iliac arteries) treated with MFM in very high risk patients. 53 MFM implanted (1 to 5 per pt). o Technical success: 100% o At 30 days: no neurological complication, branch patency 100%, no death o During the follow up we had 3 deaths not device related. CT scan control performed at 1, 3, 6, 12, 18 months with calculation of A. Diameters and Volumes. o All collateral branches remain patent and we observed a progressive thrombosis and shrinkage of the aneurysmal sac depending on the size of the collaterals. Some patients developed a thrombus after 1 month, some after 6 months and someeven after 18 months. A significant mean diameter reduction was observed between baseline and 6 months: 17,25 mm reduction for the transversal diameter, 13,83 mm for the antero posterior diameter in the TAAA group. Overtime the ratio thrombus volume / Total Volume is increasing and the ratio Residual Flow Volume / Total Volume is decreasing. The problems of thrombosis, shrinkage and volume reduction of the aneurysmal sac will be discussed. The complications rates with M.F.M appear lower in comparison with current endovascular techniques, and with surgery. Conclusions: The M.F.M represents an alternative to current devices to treat TAAA and AAA. It is a safe procedure with a low complication rate. The first results are promising. A larger study is ongoing.