Stent-assisted balloon dilatation of chronic aortic dissection.

Abstract Objectives The treatment of complicated chronic aortic dissection is still controversial. We previously reported encouraging early results with the Stent-assisted balloon-induced intimal disruption and relamination of aortic dissection (STABILISE) technique for the treatment of complicated acute aortic dissections. However, there have been no specific reports on the treatment of complicated chronic aortic dissections with this technique to date. The aim of this study was to assess the results of the STABILISE technique to treat complicated chronic aortic dissection. Methods A single-center prospectively-maintained database enrolled all patients hospitalized for aortic dissection at our institution. Inclusion criteria for the STABILISE procedure at the chronic stage of dissection (>3 months) were post-dissection aneurysm with a diameter > 55 mm or rapid aortic diameter growth > 5 mm/6 months. We reviewed all patients treated with the STABILISE technique to treat complicated chronic aortic dissection. Patients were monitored at 3, 6 and 12 months, and thereafter annually with clinical, imaging, and laboratory studies. Outcome analyses included survival, rupture, spinal cord ischemia, endoleak, morbidity (cardiac, renal or pulmonary), reinterventions, false lumen patency and aneurysm growth. Results From September 2015 to December 2018, 17 patients underwent a STABILISE procedure for complicated chronic aortic dissection of the descending aorta. Fifteen patients were treated for remaining chronic distal thoraco-abdominal aortic dissection after acute DeBakey type I aortic dissection repair and two for chronic type B aortic dissection.Median age was 61 years (range 46-67). Median interval between the onset of acute symptoms and the procedure was 9 months (range 3-67). Indications for the STABILISE procedure were a rapidly growing dissected aortic diameter > 5 mm/6 month (n=13), aneurysmal evolution of the descending thoracic aorta > 55mm (n=4). There were no cases of in-hospital death, stroke, spinal cord ischemia, ischemic colitis or renal failure requiring dialysis. Median length of follow-up was 17 months (range 5-28.5). At the last Computed Tomography scan, 15 patients (88%) had complete false lumen thrombosis of the treated thoraco-abdominal aorta down to the renal arteries. None of the patients had aortic growth at treated thoraco-abdominal aorta level. One patient developed a proximal type 1 endoleak and required reintervention. Regarding the untreated aorto-iliac level below the renal arteries, 11 patients had persisting false lumen patency and one patient developed a common iliac artery aneurysm. All the other patients had stable infra-renal aorto-iliac diameters. No late deaths were reported during follow-up. Conclusion The STABILISE technique is a safe and effective means of performing immediate, complete aortic remodeling of the thoraco-abdominal aorta in patients with complicated chronic aortic dissection, thus stabilizing the diameter of the dissected aorta.