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