Bare metal stenting for endovascular exclusion of aortic arch thrombi.
BACKGROUND
Aortic thrombi in the ascending aorta or aortic arch are rare but are associated with a relevant risk of major stroke or distal embolization. Although stent grafting is commonly used as a treatment option in the descending aorta, only a few case reports discuss stenting of the aortic arch for the treatment of a thrombus. The use of bare metal stents in this setting has not yet been described.


METHODS
We report two cases of ascending and aortic arch thrombus that were treated by covering the thrombus with an uncovered stent. Both procedures were performed under local anesthesia via a femoral approach. A femoral cutdown was used in one case, and a total percutaneous insertion was possible in the second case.


RESULTS
Both procedures were successfully performed without any periprocedural complications. Postoperative recovery was uneventful. In both cases, no late complications or recurrent embolization occurred at midterm follow-up, and control CT angiography at 1 respectively 10 months revealed no stent migration, freely perfused supra-aortic branches, and no thrombus recurrence.


CONCLUSIONS
Treating symptomatic thrombi in the ascending aorta or aortic arch with a bare metal stent is feasible. This technique could constitute a minimally invasive alternative to a surgical intervention or complex endovascular therapy with fenestrated or branched stent grafts.
Department of Diagnostic Radiology, University Hospital Giessen and Marburg, Philipps University of Marburg, Baldingerstrasse, 35033, Marburg, Germany. mahnken@med.uni-marburg.de
Andreas H
AH
Mahnken
Andras
A
Hoffman
Rüdiger
R
Autschbach
Anneke L M
AL
Damberg
D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061214:Patient Safety; D011474:Prosthesis Design; D018570:Risk Assessment; D012494:Sampling Studies; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D008670:Metals