Improved Remodeling With TEVAR and Distal Bare-Metal Stent in Acute Complicated Type B Dissection.

BACKGROUND: The ASSIST (A multicentre Study in Survivors of type B aortic dissection undergoing Stenting) study compared both 1-year outcomes and evolution of true and false lumen (eg, remodeling) in patients with complicated type B aortic dissection subjected to thoracic endovascular aortic repair (TEVAR) with distal true lumen scaffolding by self-expanding nitinol open stent in comparison with TEVAR alone. METHODS: The ASSIST study was a multicenter prospective single-arm study comparing clinical and imaging data from 39 consecutive patients (59.4 ± 13 years of age) who received TEVAR and the JOTEC E-XL open stent with data from matched control subjects treated with TEVAR alone based on 1:1 propensity score matching. Clinical data were collected by an independent Contract Research Organization (CRO) and computed tomography images were subjected to blinded core-lab analysis. RESULTS: There were no differences in baseline demographics, clinical profiles, morphological data, procedural details, and in-hospital and 1-year outcomes between groups. Differences emerged with regard to evolution of both true lumen distal to stent graft, false lumen over the entire length of dissection, and remodeling (P < .001). At 1 year, TEVAR with the E-XL stent revealed false lumen thrombosis at the level of celiac trunk in 53.8% vs 17.9% with TEVAR alone (P = .004). Kaplan-Meier survival analysis indicated favorable clinical outcomes with the additional E-XL stent. CONCLUSIONS: TEVAR for acute complicated type B aortic dissection proved to be safe and promoted remodeling of the stent grafted thoracic aorta. Additional scaffolding of the true lumen distal to TEVAR with a self-expanding stent supported distal true lumen expansion, false lumen regression, and thrombosis, with evidence of improved distal remodeling at 1 year.

Mechanolytic management of transcatheter aortic valve thrombosis.

Data on the incidence, characteristics, and treatment of thrombosis of a transcatheter aortic valve implantation (TAVI) implant are scarce. We report a challenging case of a TAVI thrombosis occurring 6 months after the procedure. Initial anticoagulation using low-molecular-weight heparin followed by thrombolytic therapy failed to both relieve symptoms and alleviate thrombosis. However, the condition of the patient deteriorated rapidly, necessitating the use of balloon valvuloplasty followed by low-dose thrombolysis. The uniqueness of the case can be summarized as follows: (1) first report of balloon valvuloplasty to manage a case of TAVI thrombosis; (2) thrombolytic therapy after balloon valvuloplasty was successful to further reduce gradient from valve thrombosis.