Dual lumen intervention for aortic dissection: long-term impact on aortic remodeling

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has changed the management of aortic dissection and enabled the dissected segment to remodel. In this report we describe the concept of dual lumen intervention with both stent-grafts in the true lumen and thrombus promoting interventions to the false lumen in the attempt to remodel dissected aorta regardless of location. METHODS: A total of 10 patients with aortic dissection (5 type A; 5 type B) underwent dual lumen intervention using a combination of patent foramen ovale (PFO) or atrial septal defect (ASD) occluders, coils and glue in addition to endovascular stenting of the true lumen. Patients were followed by computed tomography (CT) angiogram prior to, 6 months and 2 years following discharge to evaluate the status of aortic remodeling. The analysis comprised successful device delivery, completeness of false lumen thrombosis and aortic remodeling and procedure related complications. RESULTS: Dual lumen interventions have induced aortic remodeling in all cases of proximal dissection, with aortic shrinkage from 63.8±7.5 pre-intervention, 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 false lumen flow), false lumen intervention induced false lumen thrombosis in 4 of 5 cases upon 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 preintervention and 54.4±13.7 mm at 2 years 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 stable remodeling. CONCLUSIONS: Interventional false lumen management of both lumens in case of subacute/chronic aortic dissection is feasible, promotes false lumen thrombosis and induces successful remodeling with or without previous endografting.