Endovascular stent-graft placement for the treatment of acute aortic dissection

Michael D. Dake, Noriyuki Kato, R. Scott Mitchell, Charles P. Semba, Mahmood K. Razavi, Takatsugu Shimono, Tadanori Hirano, Kan Takeda, Isao Yada, D. Craig Miller

Research output: Contribution to journalArticle

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Abstract

Background The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable. Methods We studied the placement of endovascular stent-grafts across the primary entry tear for the management of acute aortic dissection originating in the descending thoracic aorta. We evaluated the feasibility, safety, and effectiveness of transluminal stent-graft placement over the entry tear in 4 patients with acute type A aortic dissections (which involve the ascending aorta) and 15 patients with acute type B aortic dissections (which are confined to the descending aorta). Dissections involved aortic branches in 14 of the 19 patients (74 percent), and symptomatic compromise of multi pie branch vessels was observed in 7 patients (37 percent). The stent-grafts were made of self-expanding stainless-steel covered with woven polyester or polytetrafluoroethylene material. Results Placement of endovascular stent- grafts across the primary entry tears was technically successful in all 19 patients. Complete thrombosis of the thoracic aortic false lumen was achieved in 15 patients (79 percent), and partial thrombosis was achieved in 4 (21 percent). Revascularization of ischemic branch vessels, with subsequent relief of corresponding symptoms, occurred in 76 percent of the obstructed branches. Three of the 19 patients died within 30 days, for an early mortality rate of 16 percent (95 percent confidence interval, 0 to 32 percent). There were no deaths and no instances of aneurysm or aortic rupture during the subsequent average follow-up period of 13 months. Conclusions These initial results suggest that stentgraft coverage of the primary entry tear may be a promising new treatment for selected patients with acute aortic dissection. This technique requires further evaluation, however, to assess its therapeutic potential fully.

Original languageEnglish (US)
Pages (from-to)1546-1552
Number of pages7
JournalNew England Journal of Medicine
Volume340
Issue number20
DOIs
StatePublished - May 20 1999
Externally publishedYes

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Blood Vessel Prosthesis
Thoracic Aortic Aneurysm
Dissecting Aneurysm
Aortic Aneurysm
Acute Disease
Stents
Aorta
Dissection
Hypertension
Transplants
Tears
Thoracic Aorta
Therapeutics
Thrombosis
Aortic Rupture
Polyesters
Mortality
Stainless Steel
Polytetrafluoroethylene
Aneurysm

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Dake, M. D., Kato, N., Mitchell, R. S., Semba, C. P., Razavi, M. K., Shimono, T., ... Miller, D. C. (1999). Endovascular stent-graft placement for the treatment of acute aortic dissection. New England Journal of Medicine, 340(20), 1546-1552. https://doi.org/10.1056/NEJM199905203402004

Endovascular stent-graft placement for the treatment of acute aortic dissection. / Dake, Michael D.; Kato, Noriyuki; Mitchell, R. Scott; Semba, Charles P.; Razavi, Mahmood K.; Shimono, Takatsugu; Hirano, Tadanori; Takeda, Kan; Yada, Isao; Miller, D. Craig.

In: New England Journal of Medicine, Vol. 340, No. 20, 20.05.1999, p. 1546-1552.

Research output: Contribution to journalArticle

Dake, MD, Kato, N, Mitchell, RS, Semba, CP, Razavi, MK, Shimono, T, Hirano, T, Takeda, K, Yada, I & Miller, DC 1999, 'Endovascular stent-graft placement for the treatment of acute aortic dissection', New England Journal of Medicine, vol. 340, no. 20, pp. 1546-1552. https://doi.org/10.1056/NEJM199905203402004
Dake, Michael D. ; Kato, Noriyuki ; Mitchell, R. Scott ; Semba, Charles P. ; Razavi, Mahmood K. ; Shimono, Takatsugu ; Hirano, Tadanori ; Takeda, Kan ; Yada, Isao ; Miller, D. Craig. / Endovascular stent-graft placement for the treatment of acute aortic dissection. In: New England Journal of Medicine. 1999 ; Vol. 340, No. 20. pp. 1546-1552.
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AU - Kato, Noriyuki

AU - Mitchell, R. Scott

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AU - Razavi, Mahmood K.

AU - Shimono, Takatsugu

AU - Hirano, Tadanori

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AU - Yada, Isao

AU - Miller, D. Craig

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N2 - Background The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable. Methods We studied the placement of endovascular stent-grafts across the primary entry tear for the management of acute aortic dissection originating in the descending thoracic aorta. We evaluated the feasibility, safety, and effectiveness of transluminal stent-graft placement over the entry tear in 4 patients with acute type A aortic dissections (which involve the ascending aorta) and 15 patients with acute type B aortic dissections (which are confined to the descending aorta). Dissections involved aortic branches in 14 of the 19 patients (74 percent), and symptomatic compromise of multi pie branch vessels was observed in 7 patients (37 percent). The stent-grafts were made of self-expanding stainless-steel covered with woven polyester or polytetrafluoroethylene material. Results Placement of endovascular stent- grafts across the primary entry tears was technically successful in all 19 patients. Complete thrombosis of the thoracic aortic false lumen was achieved in 15 patients (79 percent), and partial thrombosis was achieved in 4 (21 percent). Revascularization of ischemic branch vessels, with subsequent relief of corresponding symptoms, occurred in 76 percent of the obstructed branches. Three of the 19 patients died within 30 days, for an early mortality rate of 16 percent (95 percent confidence interval, 0 to 32 percent). There were no deaths and no instances of aneurysm or aortic rupture during the subsequent average follow-up period of 13 months. Conclusions These initial results suggest that stentgraft coverage of the primary entry tear may be a promising new treatment for selected patients with acute aortic dissection. This technique requires further evaluation, however, to assess its therapeutic potential fully.

AB - Background The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable. Methods We studied the placement of endovascular stent-grafts across the primary entry tear for the management of acute aortic dissection originating in the descending thoracic aorta. We evaluated the feasibility, safety, and effectiveness of transluminal stent-graft placement over the entry tear in 4 patients with acute type A aortic dissections (which involve the ascending aorta) and 15 patients with acute type B aortic dissections (which are confined to the descending aorta). Dissections involved aortic branches in 14 of the 19 patients (74 percent), and symptomatic compromise of multi pie branch vessels was observed in 7 patients (37 percent). The stent-grafts were made of self-expanding stainless-steel covered with woven polyester or polytetrafluoroethylene material. Results Placement of endovascular stent- grafts across the primary entry tears was technically successful in all 19 patients. Complete thrombosis of the thoracic aortic false lumen was achieved in 15 patients (79 percent), and partial thrombosis was achieved in 4 (21 percent). Revascularization of ischemic branch vessels, with subsequent relief of corresponding symptoms, occurred in 76 percent of the obstructed branches. Three of the 19 patients died within 30 days, for an early mortality rate of 16 percent (95 percent confidence interval, 0 to 32 percent). There were no deaths and no instances of aneurysm or aortic rupture during the subsequent average follow-up period of 13 months. Conclusions These initial results suggest that stentgraft coverage of the primary entry tear may be a promising new treatment for selected patients with acute aortic dissection. This technique requires further evaluation, however, to assess its therapeutic potential fully.

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