What is the clinical evidence from this study?

Study design: Case Report. Population: Circumferential type B aortic dissection (n=1). Intervention: Staged right-to-left carotid bypass and TEVAR with GORE TAG Thoracic Branch Endoprosthesis.

What does this research mean for the field?

Staged right-to-left carotid bypass followed by thoracic endovascular aortic repair (TEVAR) with a GORE TAG Thoracic Branch Endoprosthesis is a viable treatment approach for high-risk circumferential type B aortic dissection requiring zone 1 proximal landing. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe the endovascular management and reconstruction strategy for a patient presenting with high-risk circumferential type B aortic dissection.

November 11, 2024Radiology Case ReportsOpen Access

Management and follow-up of patient with circumferential type B aortic dissection using GORE thoracic-branch endograft

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Key result

Staged carotid bypass and branched TEVAR treats high-risk circumferential type B aortic dissection.

Why the study?

Type B aortic dissection with high-risk features has a greater chance of progression and rupture, but traditional TEVAR with proximal zone 1 landing requires extensive aortic arch debranching to minimize ischemic stroke risk.

Key Points

To describe the endovascular management and reconstruction strategy for a patient presenting with high-risk circumferential type B aortic dissection.
Evaluated a 53-year-old male presenting with a circumferential type B aortic dissection complicated by high-risk features including a large entry tear and false lumen.
Conducted a staged right-to-left carotid bypass followed by thoracic endovascular aortic repair with a GORE TAG Thoracic Branch Endoprosthesis for proximal zone 1 landing.
Achieved successful coverage and exclusion of the aortic dissection with an endovascular zone 1 landing.
Eliminated the requirement for invasive open aortic arch debranching while maintaining cerebral perfusion to reduce ischemic stroke risk.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

1 53-year-old male with circumferential type B aortic dissection and higher-risk features (large entry tear, false lumen)

Intervention

Staged right-to-left carotid bypass and subsequent thoracic endovascular aortic repair with a GORE TAG Thoracic Branch Endoprosthesis for zone 1 proximal landing

Demonstrates the feasibility of using a thoracic branch endoprosthesis with staged carotid bypass for complex type B aortic dissection requiring zone 1 landing.

Implication

Supports feasibility in one complex case; hypothesis-generating and should not yet alter practice or guidelines.

Abstract

Type B aortic dissection with high-risk features such as a large entry tear, false lumen, and circumferential dissection has a greater chance of progression and rupture without definitive surgical intervention. Traditional thoracic endovascular aortic repair of dissection with proximal zone 1 landing requires extensive aortic arch debranching to minimize the risk of ischemic stroke with endograft deployment. Recent developments in endovascular grafts for thoracic endovascular aortic repair have allowed for an optimized approach in challenging cases. We present the case of a 53-year-old male with circumferential type B aortic dissection and higher-risk features treated with a staged right-to-left carotid bypass and subsequent thoracic endovascular aortic repair with a GORE Ⓡ TAG Ⓡ Thoracic Branch Endoprosthesis for zone 1 proximal landing.

Discussion

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Published by Radiology Case Reports · CC BY-NC-ND

Cite This Study

Malkoc et al. (2024) conducted a case report in Circumferential type B aortic dissection (n=1). Staged right-to-left carotid bypass and TEVAR with GORE TAG Thoracic Branch Endoprosthesis was evaluated. Staged right-to-left carotid bypass and subsequent TEVAR with a GORE TAG Thoracic Branch Endoprosthesis was utilized to treat a 53-year-old male with high-risk circumferential type B aortic dissection.

synapsesocial.com/papers/6a144ff82ecb6dc54189943f https://doi.org/10.1016/j.radcr.2024.10.099

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Implication

Supports feasibility in one complex case; hypothesis-generating and should not yet alter practice or guidelines.

Management and follow-up of patient with circumferential type B aortic dissection using GORE thoracic-branch endograft

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Management and follow-up of patient with circumferential type B aortic dissection using GORE thoracic-branch endograft

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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