Management of a Malpositioned Ascyrus Medical Dissection Stent: Hybrid and Sequential Approach.
Guillaume Le Fevere de Ten Hove, Arnaud Colle, Laurent de Kerchove et al.
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Case in brief
A 53-year-old man with acute type A aortic dissection extending from the aortic root to the iliac arteries underwent emergency ascending aortic replacement, Ascyrus Medical Dissection Stent (AMDS) implantation, and brachiocephalic trunk reimplantation. Imaging showed incomplete stent expansion and persistent false lumen perfusion, followed by rapid descending aortic aneurysmal progression. Hybrid reintervention with intrathoracic debranching and thoracic endovascular aortic repair (TEVAR) was successful. At 18 months, the arch had enlarged from 69 × 64 mm to 78 × 70 mm because of retrograde false lumen perfusion. TEVAR extension and false lumen occlusion achieved sealing and favorable recovery.
What made this case unusual
Despite initial hybrid repair, retrograde false lumen perfusion was associated with further aortic arch enlargement, requiring a sequential TEVAR extension and false lumen occlusion.
Diagnostic / clinical pearl
After AMDS implantation for acute type A dissection, assess stent expansion and false lumen perfusion on imaging; persistent perfusion may accompany progressive aortic enlargement and require further intervention.
Why it matters
The case highlights the need for ongoing imaging surveillance and coordinated multidisciplinary management after repair, including when an initial reintervention has been successful.