A silent threat turned fatal: Aortic rupture following balloon angioplasty for multilayer flow modulator stent thrombosis – A case report

Abstract

Multilayer flow modulator (MFM) stents have been reported in the literature as an alternative endovascular option in selected patients with complex aortic pathologies involving visceral branches, particularly when conventional open surgery or advanced branched or fenestrated endovascular techniques are unsuitable. We report a fatal complication following balloon angioplasty of a thrombosed MFM stent in a patient with chronic type B aortic dissection. A 58-year-old man presented with uncontrolled hypertension and acute renal failure two months after thoracic endovascular aortic repair with distal MFM stent extension. Imaging revealed subtotal thrombosis of the MFM stent due to inadequate proximal and distal expansion. Balloon angioplasty was performed to restore flow; however, the patient subsequently developed distal abdominal aortic rupture, necessitating emergency open surgical repair. Despite operative intervention, the patient died from multiple organ failure. This case highlights the potential catastrophic consequences of balloon angioplasty in thrombosed MFM stents and underscores the need for extreme caution when considering re-expansion strategies in fragile aortic segments.