Stent strut penetration during thoracic endovascular aortic repair: report of a case

Abstract

We experienced a serious complication of proximal stent strut penetration (PSSP) during thoracic endovascular aortic repair in a 74-year-old man who underwent two-stage hybrid treatment for a distal arch thoracic aortic aneurysm. First, a debranching right common carotid-left common carotid-left subclavian artery bypass was performed. Second, a TALENT Thoracic Stent Graft (Medtronic, Tokyo, Japan) was inserted at Zone 1 (Ishimaru). At deployment, a proximal bare strut accidentally everted and penetrated the aortic wall vertically. Postoperative computed tomography revealed that one crown of the proximal strut had penetrated the aortic wall vertically and had produced an intramural hematoma around the strut. The patient was observed carefully and discharged from the hospital without any sequelae. Seven months after the procedure, there was no remarkable change and his aneurysm was well excluded. PSSP can cause retrograde type-A aortic dissections. A bare strut tends to cause proximal strut penetration more frequently than a covered strut. More caution should be taken in the deployment of a stent graft with a bare strut.

Partial debranching hybrid stent graft for distal aortic arch aneurysms

“…We performed coil embolization of the LSA for a type-2 endoleak in five patients. Localized intramural hematoma of the aortic wall developed in one of the patients with a TALENT thoracic stent graft, caused by penetration of a proximal bare stent [5]. This patient was treated conservatively.…”

“…However, this proximal stent also carries a risk of bare-spring eversion. In the present series, one patient suffered a localized intramural hematoma of the aortic wall, caused by penetration of the proximal stent [5]. Kasirajan et al [21] reported misaligned deployments of the TALENT at a rate of 0.1%.…”

Filament inadequate wall apposition of the different ends of flow diverters in the abdominal aorta of rabbits

“…In the peripheral vascular intervention field, the rate of filter filament penetration ranges from 9% to 24% in the inferior vena cava; filaments may even exit the vena cava to enter the aorta. 12 Tadakoshi et al 9 found that stent filament penetration triggered aortic dissection during treatment of a distal-arch thoracic aortic aneurysm. We speculate that two factors trigger PVW.…”

“…12 Tadakoshi et al. 9 found that stent filament penetration triggered aortic dissection during treatment of a distal-arch thoracic aortic aneurysm.…”

“…During peripheral vascular interventions, the end of the stent filament PVW is uncommon but can potentially cause severe complications. [9][10][11][12] Flared ends (FEs) and straight ends (SEs) are the common shapes of the end of the intracranial stent.…”