Stent Assisted Balloon Induced Intimal Disruption and Relamination in Aortic Dissection Repair: The...
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St ent A ssisted B alloon Induced I ntimal Disruption and Rel amination in Aortic Dis section Re pair: The STABILISE Concept Sophie C. Hofferberth 1 , Andrew E. Newcomb 2 , Michael Y. Yii 2 , Ian K. Nixon 2 , Peter J. Mossop 3 1. Department of Medicine, University of Melbourne (St. Vincent’s) 2. Department of Cardiac Surgery 3. Department of Medical Imaging St. Vincent’s Hospital, Melbourne, Australia
Stent Assisted Balloon Induced Intimal Disruption and Relamination in Aortic Dissection Repair: The STABILISE Concept Sophie C. Hofferberth 1, Andrew E
Stent Assisted Balloon Induced Intimal Disruption and
Relamination in Aortic Dissection Repair: The STABILISE Concept
Sophie C. Hofferberth 1, Andrew E. Newcomb 2, Michael Y. Yii 2, Ian
K. Nixon 2, Peter J. Mossop 3 1. Department of Medicine, University
of Melbourne (St. Vincents) 2. Department of Cardiac Surgery 3.
Department of Medical Imaging St. Vincents Hospital, Melbourne,
Australia
Slide 2
Background Existing endovascular techniques fail to achieve
complete repair of the distal thoracoabdominal aorta. Residual FL
patency, high velocity re-entry jets and retrograde flow into
treated zones increase risk of; -aneurysmal degeneration, rupture,
distal reoperation STABLE technique (combined proximal endograft +
distal bare metal stenting) -improved rates of aortic remodelling
through stent support of distal true lumen -incomplete intimal
relamination: >50% patients with residual FL perfusion at
midterm FU We evolved STABLE to the STABILISE technique to address
the problem of residual FL perfusion
Slide 3
STABILISE CONCEPT OBJECTIVE To achieve complete aortic
reconstruction during endovascular AD repair via stent-assisted,
balloon induced intimal rupture and relamination; leading to
elimination of false lumen perfusion and subsequent prevention of
remote phase complications.
Slide 4
Methods April 2007- Sept 2011: 27 patients underwent
endovascular AD repair Outcomes Measured Clinical: Procedural, 30
Day morbidity/mortality, Intermediate FU Aortic remodelling: CT
angiogram assessment: Aortic diameter, TL index, FL perfusion
-Thoracic Aorta: Level of Carina -Abdominal Aorta: Level of celiac
axis, Renal arteries, Infrarenal STABILISE treatment (n=11) 7 type
A, 4 acute Type B Mean age: 50 9 years STABILISE Inclusion Criteria
i) Descending thoracoabdominal aortic diameter (distal endograft
landing zone) 40mm ii) Non aneurysmal abdominal aorta with true
lumen collapse iii) No evidence of periaortic hematoma / rupture in
zone to be stented
Slide 5
STABILISE: Combined Zenith TX2- Zenith Dissection Stent /CODA
balloon therapy TX2 Exclusion ZDS Re-lamination CODA Expansion Time
from Initial Event to STABILISE Procedure = 4.6 (1-12) days Mean
No. devices deployed = 3.3 1.0 Post-Procedure
Slide 6
Operative Technique
Slide 7
Early Outcomes Technical success in all patients: n=11 30 Day
mortality: n= 1 (9%) -49 y.o, acute type A AD, presented
post-proximal repair -unexpected aortic rupture: autopsy reported
localised dehiscence at distal anastomosis site of ascending aortic
graft No strokes No spinal cord/limb/visceral ischemia No renal
failure No respiratory failure Mean Length Hospital stay: 15 13
days