Successful treatment of a stanford type a dissection by percutaneous placement of a covered stent graft in the ascending aorta Kai Ihnken, MD, Daniel.

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Presentation transcript:

Successful treatment of a stanford type a dissection by percutaneous placement of a covered stent graft in the ascending aorta Kai Ihnken, MD, Daniel Sze, MD, PhD, Michael D Dake, MD, Dominik Fleischmann, MD, Pieter Van Der Starre, MD, PhD, Robert Robbins, MD The Journal of Thoracic and Cardiovascular Surgery Volume 127, Issue 6, Pages 1808-1810 (June 2004) DOI: 10.1016/j.jtcvs.2003.12.019

Figure 1 CT angiography before treatment. A, Axial CT image shows intimal tear (arrow) in ascending aorta with severe intramural hemorrhage (arrowheads). B, Oblique-sagittal reformatted image shows intimal tear (arrow) at undersurface of distal ascending aorta. C and D, Three-dimensional volume-rendered images illustrate relationship of left coronary artery (LCA) and supra-aortic branches to intimal tear (arrow). RBCA, Right brachiocephalic artery; RCA, right coronary artery. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1808-1810DOI: (10.1016/j.jtcvs.2003.12.019)

Figure 2 Intra-arterial angiography. A, Digital subtraction angiographic image (left anterior oblique projection) shows interval development of Stanford type A aortic dissection. Intimal tear is seen on undersurface of distal ascending aorta (arrow). Faint opacification is visible on false lumen (arrowheads). B, Predeployment angiographic image shows stent graft folded on delivery device (open arrow). Bare stent is seen in brachiocephalic artery (curved arrow). TEE, Transesophageal echocardiographic probe. C, Postdeployment digital subtraction angiographic image shows closure of previous intimal tear (arrow). There is no opacification of false lumen. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1808-1810DOI: (10.1016/j.jtcvs.2003.12.019)

Figure 3 CT angiography after treatment. Axial (A) and oblique-sagittal (B) CT images at same levels as in Figure 1 confirm coverage of intimal tear with aortic stent graft. Note decreased thickness of thrombosed false lumen surrounding thoracic aorta (arrowheads). Volume-rendered views (C, D) show relationship of stent graft to left coronary artery (LCA) and right brachiocephalic artery (RBCA). The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1808-1810DOI: (10.1016/j.jtcvs.2003.12.019)