Endovascular thrombectomy in the setting of aortic dissection

2016 ◽  
Vol 9 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Michael E Reznik ◽  
Aixa Damaris Espinosa-Morales ◽  
Mouhammad A Jumaa ◽  
Syed Zaidi ◽  
Andrew F Ducruet ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Relevant Literature ◽  
Acute Type ◽  
Type B ◽  
Endovascular Thrombectomy ◽  
Intravenous Tissue Plasminogen Activator ◽  
Type B Dissection ◽  
History Of ◽  
Aortic Dissections

BackgroundRecent studies have validated the use of endovascular thrombectomy in large vessel ischemic stroke provided patients are selected appropriately. However, to our knowledge, there have been no previously reported cases of endovascular thrombectomy in patients with aortic dissection. We report three such cases, two with chronic aortic dissections (including one with a history of Marfan syndrome) and another with an acute type B dissection.MethodsCase studies and review of relevant literature.ResultsThree patients with a history of aortic dissection presented with acute onset right middle cerebral artery syndromes, two of whom had chronic aortic dissections that were status-post graft repair, while a third had an acute type B aortic dissection that had been managed with a femoral-to-femoral bypass. None of the three were candidates for intravenous tissue plasminogen activator. All three were found to have proximal right M1 occlusions on non-invasive imaging and were taken for endovascular thrombectomy via transfemoral, transradial, and transbrachial approaches, respectively. All three had successful recanalization (with Thrombolysis In Cerebral Infarction (TICI) 2b, TICI 3, and TICI 2b flow, respectively) along with clinical improvement, and none had procedure-related complications.ConclusionsThese three cases suggest that endovascular thrombectomy is feasible and can be done safely and efficaciously in patients with aortic dissections and those with Marfan syndrome, although the risks and benefits should be considered as part of any decision-making process. Given that endovascular therapy for acute stroke is now in many situations part of standard care, further studies will be necessary to delineate more precise inclusion and exclusion criteria.

Massive retrograde acute type B aortic dissection in a postpartum woman with a family history of Marfan syndrome

2008 ◽  
Vol 20 (1) ◽  
pp. 50-53 ◽  
Author(s):  
Sweeta D. Gandhi ◽  
Zafar Iqbal ◽  
Sandeep Markan ◽  
G. Hossein Almassi ◽  
Paul S. Pagel
Keyword(s):  
Family History ◽  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Postpartum Woman ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
History Of

scholarly journals Acute Type A Aortic Dissection in a 36-Week Pregnant Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Erol Kohli ◽  
Sharhabeel Jwayyed ◽  
Gary Giorgio ◽  
Mary Colleen Bhalla
Keyword(s):  
Aortic Dissection ◽  
Early Recognition ◽  
Type A ◽  
Pregnant Patient ◽  
Acute Type ◽  
Third Trimester ◽  
Type A Aortic Dissection ◽  
Increased Risk ◽  
History Of ◽  
Aortic Dissections

Aortic dissection is a relatively rare yet often fatal condition. Early recognition and treatment are crucial for survival. While the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, and a family history of aortic dissection are also at an increased risk for developing this condition. A review of the literature revealed a paucity of published cases describing the successful, emergent repair of acute type A aortic dissections in third- trimester gravid patients. We present the case of the successful diagnosis and surgical repair of a 41-year-old female who presented to the emergency department with an acute type A aortic dissection at 36 weeks of gestation.

Ascending Thoracic Aorta Dimension and Outcomes in Acute Type B Dissection (from the International Registry of Acute Aortic Dissection [IRAD])

2011 ◽  
Vol 107 (2) ◽  
pp. 315-320 ◽  
Author(s):  
Anna M. Booher ◽  
Eric M. Isselbacher ◽  
Christoph A. Nienaber ◽  
James B. Froehlich ◽  
Santi Trimarchi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Thoracic Aorta ◽  
Acute Aortic Dissection ◽  
Acute Type ◽  
Type B ◽  
International Registry ◽  
Type B Dissection

444Plasma levels of microfibrillar associated protein type 4 (MFAP4) are predictive for aortic dissection in patients with Marfan Syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M M Van Andel ◽  
S Wanga ◽  
X Yin ◽  
P Skroblin ◽  
D R Koolbergen ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Elastic Fiber ◽  
Aortic Distensibility ◽  
High Plasma ◽  
Type B ◽  
Tgf Beta ◽  
Fibrillin 1 ◽  
Aortic Dissections

Abstract Aim Marfan syndrome is a disorder with mutations in the fibrillin-1 gene, leading to elastic fiber degradation and increased TGF-beta signaling. The life-threatening feature of Marfan is aneurysm formation with a risk of fatal aortic dissections. In a proteomics screen, we identified MFAP4, a protein involved in fibrillin-1 and elastic fiber formation, to be increased in the Marfan aorta. We aim to study the role of MFAP4 in Marfan aortic disease. Methods and results MFAP4 co-localizes in the aorta with elastin and collagen fibers. In vitro experiments show that MFAP4 expression is upregulated by TGF-beta, which could explain the increased MFAP4 protein levels in the Marfan aorta. In a substudy of 96 Marfan patients from the COMPARE trial, MFAP4 levels correlate with aortic root diameter (r=0.30, p=0.01). Patients previously enrolled in the COMPARE trial were retrospectively analyzed. Cardiovascular events, including aortic dissection, were assessed. Plasma samples were prospectively collected at time of inclusion in the study and analyzed retrospectively on MFAP4. In the 7 years of follow up, 5 Type B dissections occurred, all of them in patients in the upper tertile of plasma MFAP4. High plasma MFAP4 associates with poor dissection-free survival (Figure 1). Moreover, the aortic distensibility as measure for aortic stiffness and damage, was calculated throughout the aorta from available MRI images of these patients. Interestingly, in the descending thoracic aorta where type B dissections occur, the aortic distensibility is significantly lower (indicating decreased aortic elasticity) in Marfan patients with high plasma MFAP4, thus associating with aortic damage. Figure 1 Conclusion MFAP4, a protein involved in extracellular matrix assembly, is elevated in the Marfan aorta. High plasma MFAP4 seems to reflect aortic damage and predicted type B aortic dissections in up to 7 years follow up.

Maternal and fetal outcomes in pregnancies complicated by Marfan syndrome

Heart ◽  
2019 ◽  
Vol 105 (22) ◽  
pp. 1725-1731 ◽  
Author(s):  
Matthew Cauldwell ◽  
Philip J Steer ◽  
Stephanie L Curtis ◽  
Aarthi Mohan ◽  
Samuel Dockree ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Beta Blockers ◽  
Type B ◽  
Maternal Deaths ◽  
Type B Dissection ◽  
Maternal And Neonatal Outcomes ◽  
Preconception Counselling ◽  
Aortic Size

ObjectivesInformation to guide counselling and management for pregnancy in women with Marfan syndrome (MFS) is limited. We therefore conducted a UK multicentre study.MethodsRetrospective observational study of women with MFS delivering between January 1998 and March 2018 in 12 UK centres reporting data on maternal and neonatal outcomes.ResultsIn total, there were 258 pregnancies in 151 women with MFS (19 women had prior aortic root replacements), including 226 pregnancies ≥24 weeks (two sets of twins), 20 miscarriages and 12 pregnancy terminations. Excluding miscarriages and terminations, there were 221 live births in 139 women. Only 50% of women received preconception counselling. There were no deaths, but five women experienced aortic dissection (1.9%; one type A and four type B—one had a type B dissection at 12 weeks and subsequent termination of pregnancy). Five women required cardiac surgery postpartum. No predictors for aortic dissection could be identified. The babies of the 131 (65.8%) women taking beta-blockers were on average 316 g lighter (p<0.001). Caesarean section rates were high (50%), particularly in women with dilated aortic roots. In 55 women, echocardiographic aortic imaging was available prepregnancy and postpregnancy; there was a small but significant average increase in AoR size of 0.84 mm (Median follow-up 2.3 months)ConclusionThere were no maternal deaths, and the aortic dissection rate was 1.9% (mainly type B). There with no identifiable factors associated with aortic dissection in our cohort. Preconception counselling rates were low and need improvement. Aortic size measurements increased marginally following pregnancy.

scholarly journals Review of Studies Reporting the Incidence of Acute Type B Aortic Dissection

Hearts ◽  
2020 ◽  
Vol 1 (3) ◽  
pp. 152-165
Author(s):  
Marcus Brooks
Keyword(s):  
Aortic Dissection ◽  
English Language ◽  
Hospital Admissions ◽  
Road Traffic ◽  
Acute Type ◽  
Type B ◽  
Cross Sectional ◽  
Aortic Replacement ◽  
Type B Dissection

Aortic dissection (AD) causes more deaths each year in the United Kingdom than road traffic collisions. Yet the incidence of AD is not known. The management of acute type B AD (TBAD) is changing, with the greater use of thoracic aortic stent grafts (TEVAR) in treatment and fewer open surgical procedures performed. The study’s aim is to review the worldwide, English language published, literature on acute TBAD incidence and treatment, to report on its strengths and limitations, and better understand changes in incidence over time and between countries. Thirty-one studies were identified that focus on the epidemiology and treatment of TBAD. Eight of these studies report the incidence of acute TBAD as between of 0.5–6.3 per 100,000 person years. Hospital admissions for aortic dissection are reported to be increasing in six studies and stable in one study. The proportion of patients with TBAD operated on varies between studies (range 13% to 76%). Studies identify patient age (median 51–77 years), gender (range 48%–81% male) and prevalence of cardio-vascular risk factors, specifically hypertension, in the populations studied as independent factors influencing aortic dissection incidence. Treatment of acute TBAD remains largely conservative with analgesia, hypertension control and serial cross-sectional imaging (range 24%–87% TBAD medically treated). The use of TEVAR to treat acute AD is increasing worldwide (range 13%–76% TBAD treated with TEVAR). The incidence of TBAD is under-reported due to out of hospital deaths, variable clinical presentation (miss-diagnosis) and coding errors. Importantly for research, the single International Classification of Diseases (ICD) code for aortic dissection, I17.0, does not distinguish between acute, chronic, type A or type B dissection types. Similarly, the OPCS Classification of Interventions and Procedures version 4 (OPCS-4) codes for TEVAR, L27.4 and L28.4, do not distinguish between acute and chronic AD presentation, unlike the codes for open thoracic aortic replacement. Standardised reporting of aortic dissection type, and the urgency of both the initial presentation (acute or chronic) and treatment (emergency, urgent or planned) in future studies would allow more meaningful comparisons between populations.

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