Complete Entry and Re-entry Neutralization protocol in endovascular treatment of aortic dissection

Abstract

There have been indisputable developments in techniques for stabilizing acute aortic syndromes. However, aneurysmal degeneration following aortic dissection remains a problem to be solved. The currently available treatment options for aortic dissection still fail to take into account the known risk factors for aneurysmal degeneration. This is why we introduced a new approach to treating patients with an aortic dissection, called Complete Entry and Re-entry Neutralization (CERN). This is our initial report on the promising interim results. Material and Methods: 68 patients qualified for endovascular treatment of an acute or chronic aortic dissection. Computed tomography was performed post-operatively to assess aortic remodeling after 1 /6/12/24/36 months. Results: the 30-day mortality rate was 4.4%. In 29 cases (43%) unfavorable remodeling was noted in the follow-up. The most important factors leading to unfavorable remodeling were: uncovered reentry tear including the infra-renal segment, no relining of dissection membranes and insufficient coverage of the descending aorta. We analyzed these factors to develop the CERN protocol. This concept consists of six basic rules: A. cover all entry tears, B. amplify the BMS radial force, C. use the STABILISE technique, D. consider using thrombus plugs, E. avoid stenting the visceral branches, F. spare the intercostal and lumbar side branches. CERN improves the rate of favorable remodeling from 25% to 85% (P = 0.0067). Conclusion: Introduction of the Complete Entry and Re-entry Neutralization protocol improves the rate of favorable remodeling following endovascular treatment of aortic dissection in mid-term follow-up in patients with diffused aortic dissection.