Stent-Assisted Balloon-Induced Intimal Disruption and Relamination in Aortic Dissection Repair: The STABILISE concept

Hofferberth, Sophie C.; Nixon, Ian; Boston, Raymond C.; McLachlan, Craig S.; Mossop, Peter

doi:10.1016/j.jtcvs.2013.03.036

Cited by 112 publications

(85 citation statements)

References 21 publications

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“…3C, this carries a certain risk of aortic rupture (Rynio et al, 2017). According to the STABILISE concept, if achieving full TL expansion and maintaining peripheral flow requires an intimal tear, then it is fully justified (Fanelli et al, 2016;Hofferberth et al, 2014;Kölbel et al, 2013;Midulla et al, 2011). Ballooning is quite safe if carried out inside the stent-graft (Fanelli et al, 2016;Hofferberth et al, 2014).…”

Section: Rule C True Lumen Forced Ballooningmentioning

confidence: 99%

“…According to the STABILISE concept, if achieving full TL expansion and maintaining peripheral flow requires an intimal tear, then it is fully justified (Fanelli et al, 2016;Hofferberth et al, 2014;Kölbel et al, 2013;Midulla et al, 2011). 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).…”

Section: Rule C True Lumen Forced Ballooningmentioning

confidence: 99%

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

Jędrzejczak

Rynio

Samad

et al. 2020

Reviews in Cardiovascular Medicine

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There have been indisputable developments in techniques for stabilizing acute aortic syndromes. However, aneurysmal degeneration following aortic dissection remains a problem to be solved. The currently available treatment options for aortic dissection still fail to take into account the known risk factors for aneurysmal degeneration. This is why we introduced a new approach to treating patients with an aortic dissection, called Complete Entry and Reentry Neutralization (CERN). This is our initial report on the promising interim results. Material and Methods: 68 patients qualified for endovascular treatment of an acute or chronic aortic dissection. Computed tomography was performed post-operatively to assess aortic remodeling after 1/6/12/24/36 months. Results: the 30-day mortality rate was 4.4%. In 29 cases (43%) unfavorable remodeling was noted in the follow-up. The most important factors leading to unfavorable remodeling were: uncovered reentry tear including the infra-renal segment, no relining of dissection membranes and insufficient coverage of the descending aorta. We analyzed these factors to develop the CERN protocol. This concept consists of six basic rules: A. cover all entry tears, B. amplify the BMS radial force, C. use the STABILISE technique, D. consider using thrombus plugs, E. avoid stenting the visceral branches, F. spare the intercostal and lumbar side branches. CERN improves the rate of favorable remodeling from 25% to 85% (P = 0.0067). Conclusion: Introduction of the Complete Entry and Re-entry Neutralization protocol improves the rate of favorable remodeling following endovascular treatment of aortic dissection in mid-term follow-up in patients with diffused aortic dissection.

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Section: Rule C True Lumen Forced Ballooningmentioning

confidence: 99%

Section: Rule C True Lumen Forced Ballooningmentioning

confidence: 99%

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

Jędrzejczak

Rynio

Samad

et al. 2020

Reviews in Cardiovascular Medicine

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“…A percutaneous "cheese wire" technique for creating a long fenestration has been described (23), but is technically challenging and has had limited application. A more facile technique involves the initial placement of bare metal stents in the lower thoracic and whole of the abdominal TL, which are then balloon expanded to produce a longitudinal and complete fenestration (24). The paradigm shift: total aortic repair for ATAAD Utilising the preceding deliberations, we have arrived at a novel formulation for the management of ATAAD, with the desire of combining a safe acute operation together with the potential for achieving long-term healing of the entire aorta, with minimal future complications or need for re-intervention.…”

Section: Extensivementioning

confidence: 99%

Total aortic repair for acute type A aortic dissection: a new paradigm

Matalanis

2018

J. Vis. Surg.

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Abstract:The currently accepted guidelines of open surgical repair for acute type A aortic dissection (ATAAD) include the resection of the primary entry tear, replacement of the ascending aorta and "hemiarch" with an open distal anastomosis, and aortic valve resuspension and some form of obliteration of the aortic root false lumen. The principal aim being protection against aortic rupture, aortic regurgitation, and coronary ischemia and restoration of antegrade preferential true lumen perfusion. Proponents argue that this operation is tailored to be in the armamentarium of most cardiac surgeons and deliver the lowest early operative risk, while leaving the infrequent long-term sequelae to be dealt with electively by experienced aortic centres. While a superficially compelling argument, the actual outcomes suggest that it falls significantly short of achieving its noble goals on both acute and chronic counts. This led us to develop a seemingly more radical but in practise safe paradigm, which aims to achieve total aortic healing in the acute phase.

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“…6 The STABILISE concept was published in a series with 11 patients by Mossop's group in 2014, but did not generate a lot of followers because it seemed very counterintuitive to balloon and disrupt a lamella in a dissected aorta. 7 This technique indeed includes the use of a stent graft to cover the proximal entry tear, followed by a non-covered stent over the visceral arteries (like PETTICOAT), and then additional ballooning with a larger balloon to disrupt the dissection flap with the aim of obliterating the false lumen and restoring single lumen flow. The main limitation of the technique is the maximum diameter of the aorta at the level of the visceral arteries (below 40 mm, maybe even 36 mm).…”

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confidence: 99%