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Published on: March 28, 2025
Uncovered stent implantation in complicated acute aortic dissection type B
Alexander Massmann1, Takashi Kunihara2, Peter Fries1
1Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany.
Insights
Uncovered thoracoabdominal stent placement effectively treated complicated acute aortic dissection (cAADB) with visceral ischemia. This minimally invasive approach provided midterm relief, though stent size requires careful consideration to prevent collapse.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Aortic Diseases
Background:
- Complicated acute aortic dissection (cAADB) Stanford type B presents significant risks, particularly with visceral malperfusion.
- Prompt intervention is crucial for managing cAADB to prevent catastrophic outcomes.
Purpose of the Study:
- To assess the technical feasibility and midterm outcomes of using uncovered thoracoabdominal stents in patients with cAADB.
- To evaluate the efficacy of this minimally invasive technique in resolving visceral ischemia and claudication.
Main Methods:
- A retrospective review of 14 patients with cAADB experiencing symptomatic gastrointestinal malperfusion or claudication.
- Immediate implantation of uncovered stents into the true lumen of the thoracoabdominal aorta and visceral arteries.
Main Results:
- Successful elimination of gastrointestinal ischemia and symptoms in 13 of 14 patients.
- Despite initial stent collapse in 4 cases, all patients remained asymptomatic with adequate visceral artery perfusion.
- Only one patient required secondary surgical revascularization; long-term follow-up demonstrated sustained clinical benefit.
Conclusions:
- Thoracoabdominal uncovered stent implantation is a technically feasible and effective minimally invasive treatment for cAADB with visceral ischemia.
- The procedure successfully relieved acute visceral ischemia and claudication, offering a valuable therapeutic option.
- Attention to stent sizing is important to mitigate the risk of stent collapse and ensure long-term patency.
Objective:
To retrospectively evaluate the technical feasibility and midterm results of uncovered thoracoabdominal stent placement in complicated acute aortic dissection Stanford type B (cAADB).
Patients And Methods:
Fourteen consecutive patients (3 females; range, 44-71 years) with cAADB who had symptomatic gastrointestinal malperfusion and claudication underwent immediate uncovered stent implantation (diameter, 7-28 mm; length, 40-100 mm) into the true lumen of the thoracoabdominal aorta (n = 23) and visceral arteries (n = 5).
Results:
Stenting resulted in elimination of gastrointestinal ischemia and symptoms in 13 of 14 patients; persisting symptoms led to secondary surgical revascularization in only 1 patient. More than 1 stent (≤ 4) was placed in 7 patients (2 celiac, 1 mesenteric, 2 renal, 8 aorto-iliac). Follow-up computed tomographic angiography (CTA) revealed collapse of 4 aortic stents (diameter, 9-25 mm; length, 100 mm) at 1 week in the absence of symptoms. Balloon reexpansion was possible in all 4 stents, but recollapse occurred within 1 month. Despite stent collapse, the patients remained asymptomatic; ultrasonography and CTA documented sufficient perfusion of the visceral arteries in all patients. Follow-up ranged from 6 months to 5 years (average, 2.5 years). Except for the patient who underwent iliacomesenteric bypass for unspecific abdominal pain, no other patient required additional interventional or surgical therapy.
Conclusions:
Acute aortic dissection with suspicion of visceral ischemia should prompt for immediate intervention. Thoracoabdominal uncovered stent implantation is a technically feasible and effective minimally invasive approach that provided successful relief of acute visceral ischemia and claudication in cAADB. Stent size should be less than the normal aortic diameter to avoid possible stent collapse.
