Coil Embolization for Persistent Thoracic False Lumen of Type B Aortic Dissection after Thoracic Endovascular Aortic Repair

Abstract

The natural history of the thoracic false lumen after coil embolization for type B aortic dissection (TBAD) treated by previous thoracic endovascular aortic repair (TEVAR) remains a matter of debate. The aim of this study is to assess the efficacy of coil embolization in promoting thoracic aortic remodeling of TBAD with persistent thoracic false lumen after TEVAR. Between January 2015 and December 2016, 7 consecutive TBAD patients with persistent thoracic false lumen post-TEVAR underwent coil embolization, either isolated (3 with maximum thoracic aortic diameter <55mm) or combined with adjunctive procedure(s) specifically for distal re-entry tears (4 with thoracic aneurysmal aortic dissection ≥55mm in diameter). Pre- and postcoiling computer tomography angiography (CTA) images were used to evaluate aortic remodeling via false lumen thrombosis status and maximum thoracic aorta diameter. Procedures were performed successfully in all patients, without intraoperative complications or 30-day mortality. Two dissection-related deaths occurred after hospital discharge, yielding a 6-month mortality of 28.6%. Six patients had surveillance CTA images available for analyses at median 11.2months (range 5.6-23.5) of follow-up. Thoracic aortic shrinkage and completely thrombosed thoracic false lumen were seen in 1 patient (16.7%); thoracic aortic stabilization albeit with persistent blood flow along the false lumen below or even more proximal to the embolization in 4 patients (66.7%); and continued thoracic aortic growth and aortoesophageal fistula proximal to the embolized false lumen in 1 patient. In this retrospective single center experience, the efficacy of coil embolization in promoting thoracic aortic remodeling of TBAD with persistent thoracic false lumen post-TEVAR appears to be limited, especially in patients with thoracic aneurysmal aortic dissection. Further studies are warranted to inform the optimal treatment strategy.