[Clinical Experience of Endovascular Stent-graft Treatment for Stanford Type A Acute Aortic Dissection]

Recently, thoracic endovascular aortic repair (TEVAR) is widely accepted and performed in patients with complicated and uncomplicated Stanford type B aortic dissection. However, TEVAR for Stanford type A aortic dissection is not commonly performed even in the endovascular era. This report describes patients who underwent TEVAR for Stanford type A dissection.

Since 2016, 5 patients underwent TEVAR for retrograde acute Stanford type A dissection. A covered stent-graft was placed in the descending aorta for primary entry coverage. An additional bare-stent was placed in the narrowed true lumen of the downstream aorta. A thrombosed false lumen was observed in 4 and a partially thrombosed lumen in 1 patient. No patient showed pericardial effusion, aortic insufficiency, or persistent back pain. Four of 5 patients were asymptomatic, and only 1 patient developed multiorgan malperfusion. Repetitive computed tomography (CT) was performed postoperatively.

All patients underwent successful TEVAR without the need for additional intervention, and no operative mortality and morbidity were observed. The patient with multiorgan malperfusion recovered uneventfully without any complication. Follow-up CT revealed complete disappearance of the false lumen in the ascending aorta in all patients.

Although TEVAR of the descending aorta was performed with acceptable mortality and morbidity rates in strictly selected patients with retrograde Stanford type A dissection, conceptual and technical issues remain unresolved in patients with ascending aortic stent-graft placement. Technological advances would lead to the development of innovative disease-specific endovascular devices and solutions in the future for TEVAR in patients with Stanford type A dissection.