Arch Bare Metal Stent Grafting in Type I Aortic Dissections After Hemiarch Repair

Background

DeBakey type I aortic dissections (AD) are most frequently treated with hemiarch repair. A subset of patients demonstrates persistent distal end-organ ischemia secondary to persistent true lumen (TL) compression. We describe the use of bare metal stent grafting across the residual arch dissection with the Zenith Dissection Endovascular Stent (ZDES, Cook Medical) in 7 patients with type I AD that was repaired in a hemiarch configuration with a compromised distal TL and organ malperfusion.

Methods

Seven patients underwent ZDES placement from a hemiarch repair across the arch with extension to the aortic bifurcation in the acute and subacute phases. Pressure gradients between the ascending aorta and the femoral access were recorded. Preprocedure and postprocedure computed tomographic images were analyzed using centerline reconstruction. TL and false lumen areas were calculated on the basis of manually performed measurements on 8 points along the aorta.

Results

All 7 cases were technically successful, without evidence of perioperative stroke or intraoperative death. There was a statistically significant increase in median TL area at all locations except 1 cm above the aortic bifurcation (P <.05). Pressure gradients between the ascending aorta and the femoral access in measured cases improved after stenting.

Conclusions

Bare metal stenting across the aortic arch after hemiarch repair in the setting of persistent distal TL compression is a technically viable strategy and may promote long-term aortic remodeling. This treatment strategy may represent another option for treatment of type I AD in patients presenting with distal malperfusion.