Intravascular Ultrasound for Stent Implantation in Aortic Dissection
A 48-year-old woman was admitted to our medical intensive care unit with sudden epigastric pain radiating toward both shoulders. A helical contrast-enhanced CT scan of the thorax showed Stanford type B aortic dissection extending from the left subclavian artery to the left iliac artery, with multiple communications at the level of the thoracic aorta. Considering the high risk of a surgical procedure and the near occlusion of the truncus coeliacus by the undulating dissecting lamella, in addition to intractable hypertension, a thoracic-stent graft was inserted percutaneously in an attempt to reattach the dissecting lamella and seal the communication between the true and the false lumen. Successful placement of the aortic stent-graft was performed in the catheterization laboratory under fluoroscopic and intravascular ultrasound (IVUS) guidance within 24 hours of the onset of pain.
Figure⇓ A shows the luminogram of the thoracic aorta before stent-graft insertion and a large entry between the true lumen and the false lumen (arrow). With IVUS (B, left), the entry is well identified in the 2D plane as well as in the corresponding simultaneous sagittal reconstruction of the vessel (B, right). Angiography demonstrated an excellent result after aortic stent-graft implantation (C), which was corroborated by IVUS (D). The closure of the entry site was confirmed by the beginning of the formation of a clot, as seen on IVUS (D, large arrows).
IVUS guidance is a helpful adjunct with aortic stent implantation, because it clearly identifies the guiding catheter in the true lumen and also monitors the exact positioning of the stent-graft and closure of entries. Finally, it documents both the full expansion of the stent-graft and the reconstruction of the dissected aorta, with enlargement of the true lumen and thrombosis of the false lumen.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
- Copyright © 2000 by American Heart Association