PowerPoint Presentation

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

Sophie C. Hofferberth1, Andrew E. Newcomb2, Michael Y. Yii2, Ian K. Nixon2, Peter J. Mossop3

1. Department of Medicine, University of Melbourne (St. Vincents)2. Department of Cardiac Surgery3. Department of Medical Imaging

St. Vincents Hospital, Melbourne, Australia

BackgroundExisting endovascular techniques fail to achieve complete repair of the distal thoracoabdominal aorta.

Residual FL patency, high velocity re-entry jets and retrograde flow into treated zones increase risk of; -aneurysmal degeneration, rupture, distal reoperation

STABLE technique (combined proximal endograft + distal bare metal stenting) -improved rates of aortic remodelling through stent support of distal true lumen -incomplete intimal relamination: >50% patients with residual FL perfusion at midterm FU

We evolved STABLE to the STABILISE technique to address the problem of residual FL perfusion

STABILISE CONCEPTOBJECTIVE

To achieve complete aortic reconstruction during endovascular AD repair via stent-assisted, balloon induced intimal rupture and relamination; leading to elimination of false lumen perfusion and subsequent prevention of remote phase complications.

MethodsApril 2007- Sept 2011: 27 patients underwent endovascular AD repairOutcomes Measured Clinical: Procedural, 30 Day morbidity/mortality, Intermediate FU Aortic remodelling: CT angiogram assessment: Aortic diameter, TL index, FL perfusion -Thoracic Aorta: Level of Carina-Abdominal Aorta: Level of celiac axis, Renal arteries, Infrarenal STABILISE treatment (n=11)7 type A, 4 acute Type BMean age: 50 9 years STABILISE Inclusion Criteriai) Descending thoracoabdominal aortic diameter (distal endograft landing zone) 40mm

ii) Non aneurysmal abdominal aorta with true lumen collapse iii) No evidence of periaortic hematoma / rupture in zone to be stented4STABILISE: Combined Zenith TX2- Zenith Dissection Stent /CODA balloon therapy

TX2 ExclusionZDS Re-laminationCODA Expansion Time from Initial Event to STABILISE Procedure = 4.6 (1-12) daysMean No. devices deployed = 3.3 1.0Post-Procedure 55Operative Technique

Early OutcomesTechnical success in all patients: n=11

30 Day mortality: n= 1 (9%)-49 y.o, acute type A AD, presented post-proximal repair-unexpected aortic rupture: autopsy reported localised dehiscence at distal anastomosis site of ascending aortic graft

No strokes

No spinal cord/limb/visceral ischemia

No renal failure

No respiratory failure

Mean Length Hospital stay: 15 13 days

Aortic Remodelling CarinaCeliacRenalInfrarenalAortic Remodelling****p