False lumen intervention to promote remodelling and thrombosis—The FLIRT concept in aortic dissection

Abstract

Interventional FL management, using the FLIRT concept, is feasible in selected cases of aortic dissection, promotes FL thrombosis and induces successful remodelling.

Aortic dissection: Is the false lumen really important?

“…In this issue of the journal, Yuan et al report a study of 10 patients who had an aortic dissection (50% Type A, 50% Type B) with prior interventions and were at high surgical risk. Those patients had persistent FL flow on a computed tomography angiography (CTA) scan, with >5 mm of growth during a 6‐month period.…”

“…FL interventions have previously included the “cork in the bottle neck” technique, the “candy‐plug” technique, and the “knickerbocker” technique. Those interventions resulted in several complications, including the aforementioned SINE. However, in the study by Yuan et al, the procedures focused on closing the communication between the false and true lumen by using glue (Onyx), occluder devices, and coils.…”

“…Those interventions resulted in several complications, including the aforementioned SINE. However, in the study by Yuan et al, the procedures focused on closing the communication between the false and true lumen by using glue (Onyx), occluder devices, and coils. The authors named this technique the FLIRT (FL intervention to promote remodeling and thrombosis) concept.…”

“…Although Yuan et al assessed FL procedures at a later time point than the index aortic dissection intervention, other studies have assessed concomitant FL and aortic dissection procedures. Kim et al retrospectively studied 73 patients who underwent TEVAR for chronic Type B dissection, of whom 41 underwent concomitant FL procedures.…”

“…The interventionalist must individualize the techniques to best fit the patients and their anatomy. Studies such as that by Yuan et al open the door to new techniques that may achieve better long‐term results in patients with aortic dissection. Larger, longer‐term prospective studies are warranted to better assess the importance of these strategies.…”