Endovascular Stent-Graft Placement for the Treatment of Acute Aortic Dissection

doi:10.1056/NEJM199905203402004

Volume 340:1546-1552		May 20, 1999		Number 20

Endovascular Stent–Graft Placement for the Treatment of Acute Aortic Dissection

Michael D. Dake, M.D., Noriyuki Kato, M.D., R. Scott Mitchell, M.D., Charles P. Semba, M.D., Mahmood K. Razavi, M.D., Takatsugu Shimono, M.D., Tadanori Hirano, M.D., Kan Takeda, M.D., Isao Yada, M.D., and D. Craig Miller, M.D.

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ABSTRACT

Background The standard treatment for acute aortic dissectionis either surgical or medical therapy, depending on the morphologicfeatures of the lesion and any associated complications. Irrespectiveof the form of treatment, the associated mortality and morbidityare considerable.

Methods We studied the placement of endovascular stent–graftsacross the primary entry tear for the management of acute aorticdissection originating in the descending thoracic aorta. Weevaluated the feasibility, safety, and effectiveness of transluminalstent–graft placement over the entry tear in 4 patientswith acute type A aortic dissections (which involve the ascendingaorta) and 15 patients with acute type B aortic dissections(which are confined to the descending aorta). Dissections involvedaortic branches in 14 of the 19 patients (74 percent), and symptomaticcompromise of multiple branch vessels was observed in 7 patients(37 percent). The stent–grafts were made of self-expandingstainless-steel covered with woven polyester or polytetrafluoroethylenematerial.

Results Placement of endovascular stent–grafts acrossthe primary entry tears was technically successful in all 19patients. Complete thrombosis of the thoracic aortic false lumenwas achieved in 15 patients (79 percent), and partial thrombosiswas achieved in 4 (21 percent). Revascularization of ischemicbranch vessels, with subsequent relief of corresponding symptoms,occurred in 76 percent of the obstructed branches. Three ofthe 19 patients died within 30 days, for an early mortalityrate of 16 percent (95 percent confidence interval, 0 to 32percent). There were no deaths and no instances of aneurysmor aortic rupture during the subsequent average follow-up periodof 13 months.

Conclusions These initial results suggest that stent–graftcoverage of the primary entry tear may be a promising new treatmentfor selected patients with acute aortic dissection. This techniquerequires further evaluation, however, to assess its therapeuticpotential fully.

Source Information

From the Division of Cardiovascular and Interventional Radiology (M.D.D., C.P.S., M.K.R.) and the Department of Cardiovascular and Thoracic Surgery (R.S.M., D.C.M.), Stanford University School of Medicine, Stanford, Calif.; and the Departments of Radiology (N.K., T.H., K.T.) and Thoracic and Cardiovascular Surgery (T.S., I.Y.), Mie University School of Medicine, Tsu, Japan.

Address reprint requests to Dr. Dake at the Division of Cardiovascular and Interventional Radiology, H-3647, Stanford University Medical Center, Stanford, CA 94305, or at mddake{at}leland.stanford.edu.

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