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Stent Assisted Balloon Induced Intimal Disruption and Relamination in Aortic Dissection Repair: The STABILISE Concept Sophie C. Hofferberth 1, Andrew E. Newcomb 2, Michael Y. Yii 2, Ian K. Nixon 2, Peter J. Mossop 3 1. Department of Medicine, University of Melbourne (St. Vincents) 2. Department of Cardiac Surgery 3. Department of Medical Imaging St. Vincents Hospital, Melbourne, Australia

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Background Existing endovascular techniques fail to achieve complete repair of the distal thoracoabdominal aorta. Residual FL patency, high velocity re-entry jets and retrograde flow into treated zones increase risk of; -aneurysmal degeneration, rupture, distal reoperation STABLE technique (combined proximal endograft + distal bare metal stenting) -improved rates of aortic remodelling through stent support of distal true lumen -incomplete intimal relamination: >50% patients with residual FL perfusion at midterm FU We evolved STABLE to the STABILISE technique to address the problem of residual FL perfusion

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STABILISE CONCEPT OBJECTIVE To achieve complete aortic reconstruction during endovascular AD repair via stent-assisted, balloon induced intimal rupture and relamination; leading to elimination of false lumen perfusion and subsequent prevention of remote phase complications.

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Methods April 2007- Sept 2011: 27 patients underwent endovascular AD repair Outcomes Measured Clinical: Procedural, 30 Day morbidity/mortality, Intermediate FU Aortic remodelling: CT angiogram assessment: Aortic diameter, TL index, FL perfusion -Thoracic Aorta: Level of Carina -Abdominal Aorta: Level of celiac axis, Renal arteries, Infrarenal STABILISE treatment (n=11) 7 type A, 4 acute Type B Mean age: 50 9 years STABILISE Inclusion Criteria i) Descending thoracoabdominal aortic diameter (distal endograft landing zone) 40mm ii) Non aneurysmal abdominal aorta with true lumen collapse iii) No evidence of periaortic hematoma / rupture in zone to be stented

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STABILISE: Combined Zenith TX2- Zenith Dissection Stent /CODA balloon therapy TX2 Exclusion ZDS Re-lamination CODA Expansion Time from Initial Event to STABILISE Procedure = 4.6 (1-12) days Mean No. devices deployed = 3.3 1.0 Post-Procedure

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Operative Technique

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Early Outcomes Technical success in all patients: n=11 30 Day mortality: n= 1 (9%) -49 y.o, acute type A AD, presented post-proximal repair -unexpected aortic rupture: autopsy reported localised dehiscence at distal anastomosis site of ascending aortic graft No strokes No spinal cord/limb/visceral ischemia No renal failure No respiratory failure Mean Length Hospital stay: 15 13 days

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Aortic Remodelling Carina Celiac Renal Infrarenal

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Aortic Remodelling * * * *p