A balloon-expandable intravascular stent for obliterating experimental aortic dissection Michael S. Trent, MD, Victor Parsonnet, MD, Richard Shoenfeld,

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Presentation transcript:

A balloon-expandable intravascular stent for obliterating experimental aortic dissection Michael S. Trent, MD, Victor Parsonnet, MD, Richard Shoenfeld, MD, Bruce J. Brener, MD, David E. Eisenbud, MD, Andrew S. Novick, MD, Alkiviadis Y. Campbell, MD, Michelle Ferrara-Ryan, BS, Alexander Villanueva, BA Journal of Vascular Surgery Volume 11, Issue 5, Pages 707-717 (May 1990) DOI: 10.1016/0741-5214(90)90218-Y Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Stent crimped tightly over balloon portion (to right of 2.5 cm count) of low profile catheter. Trailing portion lies relatively loosely on shaft of balloon-catheter. Journal of Vascular Surgery 1990 11, 707-717DOI: (10.1016/0741-5214(90)90218-Y) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Stent insertion and expansion technique. A, Stent on balloon-catheter inserted retrograde along guide wire. B, Stent and catheter traverses curve of aortic arch. C, Stent expanded by inflating balloon. D, With balloon deflated the catheter is withdrawn into the next portion of nonexpanded stent. E, Next portion expanded. Process repeated as needed to expand stent of any length. Journal of Vascular Surgery 1990 11, 707-717DOI: (10.1016/0741-5214(90)90218-Y) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Aorta opened at 6 weeks shows stent incorporated by aortic intima except where orifices are crossed. Note patent celiac (CA), superior mesenteric (SMA), and lumbar (L) arteries. Journal of Vascular Surgery 1990 11, 707-717DOI: (10.1016/0741-5214(90)90218-Y) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Photomicrograph illustrates the endothelialization over the stent, which occupied a position outside the tissue shown. The free space subintimally is an artifact created by the removal of the stent. (Van Gieson elastica stain; original magnification × 100.) Journal of Vascular Surgery 1990 11, 707-717DOI: (10.1016/0741-5214(90)90218-Y) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Scanning electron microscopy illustrating stent incoporation into aortic wall. Note stent (S) covered by neointima (E) and underlying matrix (M) except at celiac artery (CA) orifice. (Original magnification × 150.) Journal of Vascular Surgery 1990 11, 707-717DOI: (10.1016/0741-5214(90)90218-Y) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Technique for obliteration of aortic dissection by stent placement. A, Stent on balloon catheter inserted retrograde along guide wire in true lumen. B, Proximal portion of stent on balloon catheter inserted just proximal to point of entry of false lumen as determined by angiogram. C, Point of entry closed and that portion of dissection obliterated by expansion of balloon and stent. D, Deflated balloon withdrawn into the next portion of nonexpanded stent. E, Next portion of stent expanded. F, Process is repeated until length of stent is completely expanded, thereby obliterating the dissection along its entire length. Journal of Vascular Surgery 1990 11, 707-717DOI: (10.1016/0741-5214(90)90218-Y) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Typical group II dissection. A, Predissection aortogram with normal proximal and distal pressures. B, Dissection created (RAO projection). Note poor distal opacification and increased proximal and decreased distal systolic pressures. C, Dissection obliterated by stent. Aortogram and pressures return to normal. Journal of Vascular Surgery 1990 11, 707-717DOI: (10.1016/0741-5214(90)90218-Y) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Dissection that completely occludes proximal descending aorta (group II). A, Normal predissection aortogram. B, Dissection illustrates complete aortic occlusion (LAO projection). C, Obliteration of dissection by stent. Aortogram, proximal and distal systolic pressures return to normal. Journal of Vascular Surgery 1990 11, 707-717DOI: (10.1016/0741-5214(90)90218-Y) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 Typical group III dissection. A, Dissection immediately after formation (RAO projection). Note poor distal opacification and decreased systolic pressure. B, Distal reentry by day 7. Dissection still evident (arrow). Distal pressure improved but not normal. C, Dissection obliterated by stent placement. Aortogram, proximal and distal systolic pressures return to normal. Journal of Vascular Surgery 1990 11, 707-717DOI: (10.1016/0741-5214(90)90218-Y) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 10 Aortic cross-sectional photomicrography of two different aortas (A, B) at 6 weeks after obliteration of dissection by stent. Empty holes with neointimal coverage were occupied by stent (S). Note obliterated false lumen (L) between inner and outer layers of media (M) repaired by fibroblastic proliferation. (Van Gieson elastica stain; original magnification × 100.) Journal of Vascular Surgery 1990 11, 707-717DOI: (10.1016/0741-5214(90)90218-Y) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions