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Jaussaud N. 1, Chitsaz S. 1, Meadows A. 2, Wintermark M. 2, Cambronero N. 1, Azadani A. N. 1, Saloner D. A. 2, Chuter T. A. 1, Tseng E. E. 1
1 Division of Cardiothoracic Surgery, Department of Surgery, University of California at San Francisco Medical Center and San Francisco Veterans Affairs Medical Center, San Francisco, Ca, USA;
2 Department of Radiology, University of California at San Francisco Medical Center and San Francisco Veterans Affairs Medical Center, San Francisco, Ca, USA
Aim: The goal of this study was to identify physical characteristics of primary intimal tears in patients arriving to the hospital alive with acute type A aortic dissection using 64-multislice computerized tomography (MSCT) in order to determine anatomic feasibility of endovascular stent-grafting (ESG) for future treatment.
Methods: Radiology database was screened for acute type A aortic dissection since the time of acquisition of the 64-slice CT scanner and cross-referenced with surgical database. Seventeen patients met inclusion criteria. Images were reviewed for number, location, and size of intimal tears and aortic dimensions. Potential obstacles for ESG were determined.
Results: Ascending aorta (29%) and sinotubular junction (29%) were the most frequent regions where intimal tears originated. Location of intimal tears in nearly 75% of patients was inappropriate for ESG, and 94% of patients did not have sufficient proximal or distal landing zone required for secure fixation. Only 71% of patients underwent surgical aortic dissection repair after imaging and 86% of entry tears detected on MSCT were confirmed on intraoperative documentation. Only one patient would have met all technical criteria for ESG using currently available devices.
Conclusion: Location of intimal tear, aortic valve insufficiency, aortic diameter>38mm are major factors limiting use of ESG for acute type A dissection. Available stents used to treat type B aortic dissection do not address anatomic constraints present in type A aortic dissection in the majority of cases, such that development of new devices would be required.