Application of protective stents in endovascular repair of acute complicated Stanford type B aortic dissections.

PURPOSE: To describe the use of protective stents in the endovascular repair of acute complicated Stanford type B aortic dissections.

METHODS

From 2009 to 2011, 33 patients (27 men; mean age 47 years, range 31-73) with acute complicated Stanford type B aortic dissection underwent thoracic endovascular aortic repair (TEVAR) assisted by protective stents. In all cases, the proximal and distal landing zones differed in size by >5 mm, and the primary entry tear was in the proximal descending aorta. A bare self-expanding stent (protective stent) was deployed initially at the intended distal landing site of the primary stent-graft in the true lumen. The intention was that the bare stent would prevent excessive dilation of the distal end of the stent-graft in the vicinity of the entry tear, thus avoiding intimal rupture.

RESULTS

Successful stent deployment and sealing of the entry tear was achieved in all patients. The median diameter and length of the protective bare stents was 20.3 mm (range 18-24) and 72.7 mm (range 60-80), respectively, while the corresponding dimensions of the covered stent-grafts were 32.8 mm (range 26-40) and 157.4 mm (range 120-200 mm), respectively. There was no stent twisting, migration, of rupture of the false or true lumen. Computed tomography 1 week postoperatively demonstrated closure of the primary entry tear with thrombosis of the false lumen in all cases. No patients were lost to follow-up, which has ranged from 3 months to 3 years. No late endoleaks or stent complications, such as angulation, dislodgment, persistent leaks, branch obstruction, or stent-graft migration, have been observed, and there has been no chronic progressive true or false lumen dilatation, recurrences, or deaths.

CONCLUSION

Adjunctive use of a protective stent when treating acute Stanford type B aortic dissections in which the diameters of the proximal and distal landing zones differ by >5 mm is feasible and safe and provides good short-term outcomes.