A case of stent-assisted balloon-induced intimal disruption and relamination of distal remaining aortic dissection after the ascending aorta and aortic arch replacement for acute aortic dissection

Abstract

BackgroundThe early survival rate of patients with acute type A aortic dissection (TAAD) has improved remarkably over the past two decades. However, a false lumen may remain after proximal aortic repair and is a potential risk factor for aortic diameter enlargement, aortic rupture, and death in the chronic phase. In the stent-assisted balloon-induced intimal disruption and relamination of aortic dissection (STABILISE) technique, a stent graft is implanted at the proximal part of the aortic dissection, followed by bare-metal aortic stent placement over the distal aortic dissection. Next, an aortic balloon catheter is dilated inside the stent graft and the bare stent to disrupt the intima and collapse the false lumen, immediately restoring uniluminal thoracoabdominal aortic flow. This report describes our experience with the STABILISE technique for a residual aortic dissection after an ascending aorta, and partial aortic arch replacement for acute TAAD resulted in complications.Case presentationA 60-year-old man presented to our hospital with chest pain, paresthesia, and left lower-limb paralysis. He was diagnosed with acute type A aortic dissection (TAAD) and malperfusion of the left lower limb by computed tomography (CT), and an emergent ascending aorta and partial aortic arch replacement were performed. Immediately after surgery, the left femoral arterial pulse improved, and left lower limb revascularization was deferred. The postoperative course was good; however, back pain and intermittent claudication recurred on the 9th day after surgery. A CT examination revealed persistent antegrade false lumen flow in the descending thoracic aorta through the left subclavian artery dissection and retrograde false lumen flow from the thoracoabdominal segment, resulting in aortic diameter enlargement and narrowing of the true lumen. The symptoms did not improve, and the STABILISE technique was performed on the 12th day after the initial aortic surgery. The patient’s subsequent course was good; the back pain and intermittent claudication resolved. The patient was discharged on the 8th day after the STABILISE technique.ConclusionsThe STABILISE technique can obliterate the false lumen and resolve symptoms associated with a residual false lumen after proximal aortic repair for acute TAAD.