False lumen intervention to promote remodelling and thrombosis-The FLIRT concept in aortic dissection

Autor: Yida Tang, Xun Yuan, Mireya Castro Verdes, Christoph A. Nienaber, Esther Cambronero-Cortinas, Andreas Mitsis, Thomas Semple
Rok vydání: 2017
Předmět:
Male
Cardiac & Cardiovascular Systems
Time Factors
Computed Tomography Angiography
False lumen
Computed tomography
Aorta
Thoracic
030204 cardiovascular system & hematology
coils
false lumen
0302 clinical medicine
Risk Factors
030212 general & internal medicine
1102 Cardiorespiratory Medicine and Haematology
remodeling
Aortic dissection
Aged
80 and over
medicine.diagnostic_test
Endovascular Procedures
MIDTERM OUTCOMES
General Medicine
Middle Aged
EMBOLIZATION
Thrombosis
occluder devices
Treatment Outcome
ENDOLEAKS
Cardiology
cardiovascular system
Female
Aortic diameter
vascular plug
Cardiology and Cardiovascular Medicine
Life Sciences & Biomedicine
medicine.medical_specialty
ENDOVASCULAR ANEURYSM REPAIR
Vascular Remodeling
Aortic repair
Aortography
thoracic endovascular aortic repair
03 medical and health sciences
Internal medicine
medicine
MANAGEMENT
Humans
Radiology
Nuclear Medicine and imaging
Aged
Retrospective Studies
Science & Technology
Aortic Aneurysm
Thoracic
business.industry
medicine.disease
Aortic Dissection
Cardiovascular System & Hematology
Patent foramen ovale
Left subclavian artery
Cardiovascular System & Cardiology
business
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventions. 92(4)
ISSN: 1522-726X
Popis: Objective Thoracic endovascular aortic repair (TEVAR) has changed the management of aortic dissection by induced remodelling. Beyond reconstructing the true lumen, we describe the concept of False Lumen Intervention to promote Remodelling and Thrombosis (FLIRT) in both type A and B aortic dissection. Methods Between 2011 and 2017, 10 patients with aortic dissection (5 type A; 5 type B) underwent FLIRT using a combination of patent foramen ovale (PFO) or atrial septal defect (ASD) occluders, coils and glue. Patients were followed by computed tomography (CT) angiogram prior to, and 6 months following, discharge to evaluate false lumen (FL) thrombosis and aortic remodelling. Outcomes analyzed comprised successful device delivery, completeness of FL thrombosis and aortic remodelling, procedure related complications and mortality. Results FLIRT induced aortic remodelling in all cases of proximal dissection, with aortic shrinkage from 63.8 ± 7.5 pre-FLIRT, to 50.2 ± 6.6 mm (P = 0.057) and an increase in true lumen area from 5.8 ± 3.6 to 11.4 ± 2.5 cm2 (P = 0.006). In distal dissection (after previous TEVAR with residual FL flow), FLIRT successfully induced FL thrombosis in 4 of 5 cases at first attempt (1 case required additional coiling of the gutter between left subclavian artery and stent-graft for complete thrombosis). While maximal aortic diameter remained unchanged (55.6 ± 9.1 pre-FLIRT and 54.4 ± 13.7 mm at follow-up), true lumen area increased from 7.8 ± 2.3 pre-procedure, to 10.6 ± 1.5 cm2 at follow-up (P = 0.016), consistent with remodelling. Conclusion Interventional FL management, using the FLIRT concept, is feasible in selected cases of aortic dissection, promotes FL thrombosis and induces successful remodelling.
Databáze: OpenAIRE
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