Interventional strategies for treatment of aortic dissection.
Endovascular treatment of chronic aneurysmatic diseases of the thoracic aorta has demonstrated encouraging peri-interventional mortality and morbidity and is accepted as a preferred strategy. The emerging of endovascular strategies for acute thoracic aortic dissection is an even more exciting new territory for nonsurgical interventions considering the sobering results of open surgery. Although it is apparent that patients at high risk for open surgery will benefit from endovascular strategies, the exact role of stent-graft placement remains to be defined at present as the community awaits solid long-term data and as devices and techniques continue to improve. While some indications and scenarios such as acute type B dissection with associated malperfusion syndrome or imminent aortic rupture have shown to benefit from stent-graft treatment, others are less settled. The current paper discusses both the established and emerging indications, as well as all technical aspects of this fascinating new therapeutic alternative. Moreover, the currently available data from small studies and registries are commented and analysed. Based on the available information the cardiovascular community is in the early phase of integrating a new rapidly evolving interventional concept into the care of patients with type B aortic dissection that so far lacked a reasonable therapeutic option other than blood pressure lowering medication. With the use and interpretation of current information the reader will understand the potential of interventional stent-graft induced thoracic aortic repair in type B aortic dissection.
Nienaber
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Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Rostock, Germany. christoph.nienaber@med.uni-rostock.de
Rehders
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Ince
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D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed