Initial results of thoracic endovascular repair for uncomplicated type B aortic dissection involving the arch vessels using a semicustom-made thoracic fenestrated stent graft

Fukushima, Soichiro; Ohki, Takao; Toya, Naoki; Shukuzawa, Kota; Ito, Eisaku; Murakami, Yuri; Akiba, Tadashi

doi:10.1016/j.jvs.2018.09.028

Cited by 19 publications

(17 citation statements)

References 20 publications

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“…Atheromatous emboli were detected in the brain [28,29], and the association between atherosclerosis in the aortic arch and stroke risk have been established [30][31][32]. Stroke is known as one of the complications of endovascular aortic repair for aortic arch, and operative procedures have been improved to decrease stroke events [30,33]. Owing to the limitation of spatial and temporal resolution, only mobile plaques and !4-mm thick plaques are considered to be high risk [34].…”

Section: Strokementioning

confidence: 99%

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Spontaneous ruptured aortic plaque and injuries: insights for aging and acute aortic syndrome from non-obstructive general angioscopy

Komatsu

Takahashi

Yutani

et al. 2020

Journal of Cardiology

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Recent advances in non-obstructive general angioscopy (NOGA) have enabled the detection of aortic atherosclerosis. The incidence of spontaneous ruptured aortic plaques (SRAPs) and aortic injuries was found to be high in patients diagnosed with or suspected of having coronary artery disease. These facts may result in a paradigm shift for diseases such as aging and acute aortic syndrome because the incidence of systemic embolic diseases and aortic disease are assumed be high. Aortic thromboembolism has been thought to be mainly iatrogenic and is referred to as "cholesterol embolization syndrome" or "cholesterol crystal embolization", although the cholesterol crystals (CCs) were not demonstrated routinely as real images. Atheromatous materials, fibrins, calcifications, macrophages, and a mixture of such substances are released through a puff or puff-chandelier rupture. Among atheromatous materials, CCs can be easily detected clinically in sampled blood via polarized light microscopy. Atheromatous materials include rich CCs and free monolayers, and multilayer CCs are released when the atheromatous materials from vulnerable plaques break into pieces, such as in puff or puff-chandelier rupture. Released SRAPs seem to be asymptomatic; however, accumulation of SRAPs referred to as accumulated spontaneous asymptomatic plaques may cause aging through systemic "embolic" processes, such as mechanical obstruction and an inflammasome pathway. Unique findings in "atherosclerotic" acute aortic syndrome, such as a clear boundary between the dissected lesion and the normal lesion, fissure/fissure bleeding suggesting an entry or a reentry, and subintimal blood flow detected through NOGA are reported. Fissure/ fissure bleeding and subintimal blood flow may be the first or last triggers of "atherosclerotic" acute aortic syndrome. Pre-emptive diagnosis and risk stratification of acute "atherosclerotic" aortic dissection and feedback for endovascular therapy may be enabled through the use of NOGA in the future.

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Section: Strokementioning

confidence: 99%

“…Embolism including blue toe is known as one of the complications after stent grafting for aortic disease [86,87]. Angioscopic feedback including intimal injury after stent grafting is reported [12,88].…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Spontaneous ruptured aortic plaque and injuries: insights for aging and acute aortic syndrome from non-obstructive general angioscopy

Komatsu

Takahashi

Yutani

et al. 2020

Journal of Cardiology

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“…We previously reported the clinical outcomes of endovascular repair for aortic disease including aortic dissection, and complex aortic aneurysms [1], [2]. However, we sometimes experience an additional treatment even after EVAR, caused by an endoleak (EL), endograft infection, or endograft material deterioration [3], [4], [5].…”

Section: Introductionmentioning

confidence: 99%

A reproducible swine model of a surgically created saccular thoracic aortic aneurysm

et al. 2021

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A reproducible swine thoracic aortic aneurysm (TAA) model is useful for investigating new therapeutic interventions. We report a surgical method for creating a reproducible swine saccular TAA model. We used eight female swine weighing 20-25 kg (LWD; ternary species). All procedures were performed under general anesthesia and involved left thoracotomy. Following aortic cross-clamping, the thoracic aorta was surgically dissected and the media and intima were resected, and the dissection plane was extended by spreading the outer layer for aneurysmal space. Subsequently, only the adventitial layer of the aorta was sutured. At 2 weeks after these procedures, angiography and computed tomography (CT) were performed. After follow-up imaging, the model animals were euthanized. Macroscopic, histological, and immunohistological examinations were performed. All model animals survived, and a saccular TAA was confirmed by follow-up imaging in all cases. The mean length of the shorter and the longer aortic diameter after the procedure were 14.01 ± 1.0 mm and 18.35 ±1.4 mm, respectively (p < 0.001). The rate of increase in the aortic diameter was 131.7 ±13.8 %, and the mean length of aneurysmal change at thoracic aorta was 22.4±1.9 mm. Histological examination revealed intimal tears and defects of elastic fibers in the media. Immunostaining revealed MMP-2 and MMP-9 expressions at the aneurysm site. We report our surgical method for creating a swine saccular TAA model. Our model animal may be useful to investigate new therapeutic interventions for aortic disease.

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“…One such is the Najuta semi-custom thoracic fenestrated stent-graft (Kawasumi Laboratories, Tokyo, Japan), which is loaded in a preshaped sheath for the aortic arch configuration. 11 Another is the homemade double-fenestrated stent-graft reported by Canaud et al 12 Placement of covered stents through the oversized fenestrations in both of these devices will not result in sealing or cannot be done because of crossing struts; sealing is achieved by the aortic endograft itself, and the technique is thus suitable only for inner curve or distal arch pathology.…”

mentioning

confidence: 99%

Commentary: Treatment of Ascending Aortic Pathology With Arch Endografts That Extend Proximally

Joseph

2019

J Endovasc Ther

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Initial results of thoracic endovascular repair for uncomplicated type B aortic dissection involving the arch vessels using a semicustom-made thoracic fenestrated stent graft

Cited by 19 publications

References 20 publications

Spontaneous ruptured aortic plaque and injuries: insights for aging and acute aortic syndrome from non-obstructive general angioscopy

Spontaneous ruptured aortic plaque and injuries: insights for aging and acute aortic syndrome from non-obstructive general angioscopy

A reproducible swine model of a surgically created saccular thoracic aortic aneurysm

Commentary: Treatment of Ascending Aortic Pathology With Arch Endografts That Extend Proximally

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