Management of a Malpositioned Ascyrus Medical Dissection Stent: Hybrid and Sequential Approach

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Medical Devices

Background:

• Acute type A aortic dissection (ATAAD) is a critical surgical emergency.
• The Ascyrus Medical Dissection Stent (AMDS) aims to improve aortic remodeling post-ATAAD repair.
• Potential complications include stent malposition and persistent false lumen perfusion, necessitating further interventions.

Purpose of the Study:

• To present a case of ATAAD managed with AMDS implantation.
• To describe the management of device-related complications and aortic complications.
• To highlight the role of hybrid and endovascular reinterventions in complex aortic disease.

Main Methods:

• A 53-year-old male with ATAAD underwent emergency repair with ascending aortic replacement and AMDS implantation.
• Initial repair was followed by a hybrid reintervention involving thoracic endovascular aortic repair (TEVAR).
• A subsequent TEVAR extension with false lumen occlusion was performed to address arch enlargement.

Main Results:

• Early postoperative imaging revealed incomplete AMDS expansion and a perfused false lumen, leading to aortic aneurysmal progression.
• Hybrid reintervention successfully managed initial complications.
• Further TEVAR with false lumen occlusion achieved complete sealing and favorable recovery at 18-month follow-up.

Conclusions:

• AMDS malposition and persistent false lumen perfusion are manageable complications following ATAAD repair.
• Hybrid and endovascular reinterventions, particularly false lumen occlusion, are effective treatment strategies.
• Lifelong surveillance and specialized multidisciplinary care are essential for optimal long-term outcomes in complex aortic dissection cases.