Unexpected Bare Metal Stent Migration Associated With Aortic Remodeling After PETTICOAT Technique for Aortic Dissection

Abstract

Purpose: To report a unique case of bare metal stent migration in the overlapping zone and subsequent distal stent graft-induced new entry (SINE) after the Provisional Extension to Induce a Complete Attachment (PETTICOAT) technique for aortic dissection. Case report: A 67-year-old man underwent thoracic endovascular aortic repair (TEVAR) using the PETTICOAT technique for acute complicated type B aortic dissection. The postoperative course was uneventful, and follow-up computed tomography (CT) showed not only favorable aortic remodeling but also progressive bare metal stent migration in the overlapping zone between the stent graft and the bare metal stent. A 6-month postoperative CT revealed a distal SINE, and the patient underwent re-TEVAR to cover the new entry. Postoperative CT demonstrated successful repair of the distal SINE. The patient is currently in good health 2 years after the reintervention. Conclusion: Surgeons should consider the potential risk of device migration due to favorable aortic remodeling after TEVAR for aortic dissection, especially with the use of additional bare metal stents.

Changing Management of Type B Aortic Dissections

“…52 Furthermore, there have been occasional reports of complications related to the bare stent, including stent migration, stent fracture, and misalignment. [53][54][55] A Cochrane review of the long-term outcomes of the PETTICOAT was abandoned because the absence of randomized trials precluded definitive assessment of the technique's long-term utility. 56 A meta-analysis by Qui et al that included 914 patients in eight observational studies reported no difference in overall aorta-related mortality or complete false lumen thrombosis in the thoracic or abdominal segments.…”