Catheter-Induced Type B Aortic Dissection After TAVI: Delayed Adverse Remodeling

Catheter-induced type B aortic dissection is a rare complication of transcatheter aortic valve implantation with uncertain long-term behavior.

An 85-year-old woman developed a focal aortic isthmus dissection during transfemoral transcatheter aortic valve implantation. Initial computed tomography angiography (CTA) showed no malperfusion or rupture; conservative management and serial CTA surveillance were selected. Despite persistent clinical stability, follow-up CTA demonstrated progressive focal outpouching and pseudoaneurysmal remodeling. At 17 months, elective thoracic endovascular aortic repair achieved complete exclusion of the lesion.

Catheter-induced dissection may represent a mechanistically distinct entity from spontaneous type B aortic dissection, limiting direct extrapolation of conventional management pathways. Morphological progression, rather than symptoms or absolute aortic diameter, prompted intervention.

Clinical stability does not establish aortic wall healing. Long-term serial CTA can identify silent adverse remodeling and guide elective thoracic endovascular aortic repair in selected patients.