Risk factors for distal stent graft-induced new entry tear after endovascular repair of thoracic aortic dissection

Abstract

Objective: A review of the literature was conducted for incidence, outcomes, and risk factors for distal stent graft-induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) of aortic dissection. Methods:The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results: Seven articles reporting on 1415 patients with thoracic aortic dissection undergoing TEVAR without supplemental distal bare stenting were included. In this cohort, 86 patients were treated for a residual type A aortic dissection and 1329 for a complicated type B aortic dissection. Distal SINE occurred in 112 patients (7.9%). The mean time to identification of distal SINE was 19 6 7 months. The incidence of distal SINE after TEVAR for type B aortic dissection differed on the basis of whether it was a chronic or acute dissection repair and was, respectively, 12.9% (43/331) and 4.3% (12/273). Successful secondary interventions were performed in 54% of the patients. All the studies analyzing the relationship between distal stent graft oversizing and incidence of distal SINE reported a significantly higher rate of SINE with oversizing. Conclusions:The successful management of complicated descending thoracic aortic dissections by TEVAR is well established. Whereas distal SINE is relatively frequent, if it does occur, the complication can generally be treated with additional TEVAR without a poor outcome. The main determinant of SINE seems to be excessive distal oversizing.

Re-TEVAR in treatment of stent graft-induced new entry between two non-overlapping stent-grafts: a case report

“…SINE is an uncommon late complication of the endovascular treatment of aortic dissections with high mortality rates [2]. It can occur either at the proximal or distal end of the stent [2,3]. SINE, which was first reported by Kato et al [4] in 2001 as an aneurysmal degeneration of the aorta after TEVAR for acute aortic dissection, is one of the serious and specific complications.…”

The Evolving Role of Hybrid Arch Repair

“…In cases of acute or chronic dissections, minimal oversizing should be applied in order to prevent stentinduced new entry tears. 25 This well-described phenomenon results in persistent false-lumen perfusion and consequent negative aortic remodeling. Additional sizing considerations arise when subsequent endovascular repairs are planned.…”

Complete Entry and Re-entry Neutralization protocol in endovascular treatment of aortic dissection

“…Ballooning is quite safe if carried out inside the stent-graft (Fanelli et al, 2016;Hofferberth et al, 2014). Moreover, the implantation of BMS followed by stent-graft deployment (with overlap) prevents stent-induced distal re-dissection (SIDR) and stentinduced new entry tears (SINE) (Canaud et al, 2014(Canaud et al, , 2019He et al, 2015). Neither SIDR, nor SINE were observed if the procedure was performed in compliance with the CERN rules.…”