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Uncovered stent implantation in complicated acute aortic dissection type B  Alexander Massmann, MD, Takashi Kunihara, PhD, MD, Peter Fries, MD, Günther.

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Presentation on theme: "Uncovered stent implantation in complicated acute aortic dissection type B  Alexander Massmann, MD, Takashi Kunihara, PhD, MD, Peter Fries, MD, Günther."— Presentation transcript:

1 Uncovered stent implantation in complicated acute aortic dissection type B 
Alexander Massmann, MD, Takashi Kunihara, PhD, MD, Peter Fries, MD, Günther Schneider, PhD, MD, Arno Buecker, MD, Hans- Joachim Schäfers, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 148, Issue 6, Pages (December 2014) DOI: /j.jtcvs Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 A, Computed tomographic angiography shows a very small true lumen (arrow) of the abdominal aorta, which is nearly completely compressed by the false lumen (asterisk). The dissection extends into the celiac trunk. B, The superior mesenteric artery ostium is covered by the dissection membrane. The aortic true lumen is almost completely collapsed (arrow). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 A, Catheter angiography after contrast medium injection into the aortic true lumen results in the typical appearance of floating visceral arteries. B, Contrast injection into the aortic true lumen of the infrarenal aorta shows a high-grade stenosis due to almost complete compression of the true lumen. Inflow into the iliac arteries is markedly reduced. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 A, Angiography reveals a complete occlusion of the superior mesenteric artery originating from the complete compression of the true aortic lumen. B, Stent implantation into the true aortic lumen results in a markedly improved inflow into the superior mesenteric artery (asterisk) despite stent placement over the superior mesenteric artery ostium. Because of impaired infrarenal blood flow, additional infrarenal stenting was performed. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 A, Computed tomographic angiography depicts a slitlike configuration of the true aortic lumen, which is compressed by a large false lumen (asterisk). B, Adapted stent implantation achieved a perfused true lumen (X) of about one quarter to one third of the original aortic diameter. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 A, Computed tomographic angiography initially reveals a compressed aortic true lumen. After stent implantation into the aortic true lumen, computed tomographic angiography 2 weeks later shows stent collapse (arrows) in transverse (B) and sagittal (C) views. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

7 Figure 6 A, Follow-up computed tomographic angiography of the patient in Figure 5, 2 weeks after stent implantation revealed stent collapse. B, Balloon angioplasty resulted in a partial reexpansion of the stent. C, Follow-up computed tomographic angiography 4 weeks after reexpansion documents recollapse. D, Follow-up computed tomographic angiography another 4 weeks after recollapse depicts complete disruption of the stent struts. Despite this unsatisfactory morphologic result, the patient did not complain of clinical symptoms. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

8 Figure 7 Aortic diameter on initial and follow-up computed tomographic angiography: box and Whiskers plot (min/max/25th percentiles) with P values. asc, Ascending; FU, follow-up; desc, descending. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

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