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

BackgroundAcute type A aortic dissection (ATAAD) is a life-threatening emergency requiring urgent surgical repair. The Ascyrus Medical Dissection Stent (AMDS) has been introduced as an adjunct to facilitate true lumen expansion and promote positive aortic remodeling. However, device-related complications such as malposition and persistent false lumen perfusion can lead to aneurysmal degeneration and reintervention.Case PresentationWe report the case of a 53-year-old male patient with an ATAAD with an entry tear at the aortic root extending to the iliac arteries. Emergency repair included ascending aortic replacement with AMDS implantation, and brachiocephalic trunk reimplantation. Early postoperative imaging showed incomplete AMDS expansion and a perfused false lumen, with rapid aneurysmal progression of the descending aorta. A hybrid reintervention combining intrathoracic debranching and thoracic endovascular aortic repair (TEVAR) was performed successfully. At 18 months follow-up, further enlargement of the aortic arch (from 69 × 64 mm to 78 × 70 mm) was observed due to retrograde false lumen perfusion. A TEVAR extension with false lumen occlusion using a occluder was undertaken, achieving complete sealing and favorable postoperative recovery.ConclusionsAMDS malposition and persistent false lumen perfusion following ATAAD repair can be managed by hybrid and endovascular reinterventions, including false lumen occlusion techniques. Lifelong imaging surveillance and multidisciplinary management in specialized aortic centers are essential to ensure early detection of complications and optimize long-term outcomes.