Chest Pearls - Learning

Chest

Stent

List

Slides

Thoracic Endovascular Stents: Endoleaks
- Type I: these result from incomplete seal of the ends of the stent to the aortic wall
- Type II: result from retrograde flow of blood into excluded lumen from patent branch vesselsof the aorta
- Type III: result from junctional dehiscence or device degeneration
- Type IV: result from porosity of the stent
- Type V: are increase in size of excluded lumen w/o enhancement in excluded lumen
Thoracic Endovascular Stents: Endoleaks
- Occur in up to 29% of cases
- Five types of endoleaks occur
- Type I account for 40% of all endoleaks
Thoracic Endovascular Stents: Complications
- Collapse of stent
- Migration of stent
- Endoleak
- Pseudoaneurysm or dissection
- Pulmonary embolism
Thoracic Endovascular Stents:Indications
- Aortic aneurysms
- Acute and chronic dissection
- Penetrating ulcer
- Intramural hematoma
- Traumatic aortic rupture
"Luminal and extraluminal changes to the thoracic aorta occur after endovascular stent-grafting. The radiologist can facilitate appropriate management by detecting and differentiating expected CTA findings from complications."
MDCT Angiography of Thoracic Aorta Endovascular Stent-Grafts: Pearls and Pitfalls
Hoang JK et al.
AJR 2009; 192: 515-524
Complications of Endovascular Stent Placement
- Endoleaks
- Stent migration
- Pseudoaneurysms
- Dissection
- Aortic perforation
- Kinking
- Thrombosis
- Coverage of key arch vessels
"Postprocedure multidetector CT is mandatory to assess stent placement, efficacy, and complications. Important factors to document are location of the stent, stent patency, size of the aorta, thrombosis of disease outside the aortic lumen, and any complications."

Thoracic Aortic Stent-Grafts: Utility of Multidetector CT for Pre- and Postprocedure Evaluation
Bean MJ, Johnson PT, Roseborough GS, Black JH, Fishman EK
RadioGraphics2008; 28:1835-1851
"In this article, we discuss which patients are potential candidates for thoracic aortic stent graft placement and demonstrate how multidetector computed tomography with two dimensional multiplanar reformation (MPR) and three dimensional rendering (3D) is relevant in preoperative imaging and post operative assessment of thoracic stent grafts."

Thoracic Aortic Stent-Grafts: Utility of Multidetector CT for Pre- and Postprocedure Evaluation
Bean MJ, Johnson PT, Roseborough GS, Black JH, Fishman EK
RadioGraphics2008; 28:1835-1851
Thoracic Endovascular Stent Placement: Patient Selection
- Penetrating ulcers
- Aortic aneurysm
- Aortic dissection
- Acute traumatic aortic injury
- Aortic coartation
Thoracic Aneurysm Repair in Elderly Patients: Complications
- Mortality rate is 7-12% in elective cases
- Mortality is up to 40% in elective cases
CTA and Thoracic Stent Grafts
Pre-operative planning
Post-operative assessment

–Endoleak
–Graft movement or fracture
–Size of native aorta