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Outcomes of stent-graft treatment of false lumen in aortic dissection
Insights
Stent-graft repair effectively closes entry sites in aortic dissection, promoting false lumen clotting and size reduction. This less invasive therapy shows promising outcomes within six months post-procedure.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Vascular Medicine
Background:
- Stent-graft treatment offers a less invasive alternative to conventional surgery for aortic diseases.
- Its efficacy for aortic dissection, however, remains to be fully established.
- This study investigates stent-graft outcomes in aortic dissection patients.
Purpose of the Study:
- To evaluate the effectiveness of stent-graft treatment for aortic dissection.
- To assess key outcomes including entry site closure, false lumen thrombosis, and false lumen remodeling.
- To analyze these outcomes from the acute to chronic phases post-operation.
Main Methods:
- A custom-designed stent-graft was used in 21 patients with aortic dissection (9 acute, 8 subacute, 4 chronic; 9 Type A, 12 Type B).
- Stent-graft insertion was performed via median sternotomy (15 cases) or transfemoral catheter (6 cases).
- Computed tomographic scans were utilized for follow-up to assess entry site status, false lumen clotting, and size reduction at three defined levels.
Main Results:
- Successful entry site closure was achieved in 90.4% of cases; perigraft leakage occurred in 2 cases treated with transcatheter approach.
- Hospital mortality rate was 14.3%.
- At two weeks, complete false lumen thrombosis was observed in 100%, 77%, and 38% of cases at the measured levels. Significant false lumen shrinkage (>50%) was noted at 6 months in 72%, 60%, and 38% of cases, particularly enhanced in patients treated within 6 months of dissection onset.
Conclusions:
- Stent-graft treatment is effective for closing the entry site in aortic dissection.
- It effectively promotes false lumen thrombosis and size reduction.
- These positive remodeling effects are most pronounced within six months of dissection onset, contingent upon successful entry site closure.
Background:
Stent-graft treatment for aortic disease promises to lead to a less invasive therapy than conventional surgical therapy. However, this treatment has not been established as a therapy for aortic dissection. The aim of this study was to examine the effect of stent-graft treatment of aortic dissection, as measured by follow-up data on entry site closure, clotting in the false lumen, and the outcome of the false lumen from the acute to chronic phase after operation.
Methods And Results:
We used a stent-graft of our own design to close the entry site of aortic dissection in 21 cases: 9 were acute (< 14 days), 8 subacute (< 6 months), and 4 chronic (> 6 months). Nine were type A and 12 were type B. In 15 cases, the stent-graft was inserted through the transverse arch, which had been surgically opened under median sternotomy. In the other 6 cases, the stent-graft was inserted by means of a transcatheter through a femoral artery. Using computed tomographic scans, we followed and examined clot formation in the false lumen and reduction in size of the false lumen at 3 levels: at the level of maximum aortic diameter, at the distal end of the stent-graft, and 50 mm distal to the stent-graft. The entry sites were successfully closed in 19 cases (90.4%); in the remaining 2 (both treated with a transcatheter) there was perigraft leakage into the false lumen. The hospital mortality rate of these stent-graft treatments was 14.3% (3 of 21). At 2 weeks after operation, the false lumen had completely clotted, respectively, in 100%, 77%, and 38% of cases at the 3 measurement levels. Substantial shrinkage (> 50% in diameter) of the false lumen at 6 months after the operation was observed in 72%, 60%, and 38% of cases at the respective levels. Shrinkage of the false lumen was particularly enhanced in patients treated within 6 months from the onset of dissection: The false lumen shrank by > 50% in 93%, 75%, and 50% of patients.
Conclusions:
In cases of aortic dissection, the stent-graft is an effective tool for closing the entry site and promoting clot formation in the false lumen and for reducing the size of the false lumen within 6 months of the onset of dissection if the entry site has been closed.