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(Circulation. 2000;101:e96.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Limitations to the Therapeutic Potential of Endoluminal Stent Placement in the Thoracic Aorta

Torsten Doenst, MD; Christian Schlensak, MD; Friedhelm Beyersdorf, MD

Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany

	Introduction

 
To the Editor:

In their recent study, Rousseau et al¹ report the successful delayed treatment of traumatic rupture of the thoracic aorta by endoluminal stent placement. The results of this technique in the authors’ hands were excellent. The authors suggest that this alternative treatment to conventional surgery is feasible and safe but that its use may be restricted by limited durability of the stent graft material.

We wish to raise a point that may further limit the therapeutic potential of stent placement in the thoracic aorta. It is our experience from implanting >150 endoluminal stents into the abdominal aorta in order to exclude aneurysms that despite excellent immediate success rates, >10% of the stents had to be surgically removed within the first 4 years after stent implantation (References 2 and 3 and unpublished observations). Others have made similar observations.⁴ Surgical explantation of the stents in our patients became necessary not only because of problems with the stent durability but mainly because of dislocation of the stents and reexposure of the old aneurysms to systemic blood pressure. These dislocations were due to dilatation of the aorta at the anchoring site of the stent. Dilatation of the aorta may also occur in the thoracic aorta. Because of the elastic nature of the vessel walls, dislocation of stents may even be facilitated. Although our experience with the placement of thoracic stents is limited, we would expect a similar condition in these cases. Thus, we propose that stent graft placement into the thoracic aorta . . . [Full Text of this Article]

H. Rousseau, MD; B. Janne d’Othée, MD; P. Perreault, MD; G. Meites, MD; F. Joffre, MD; P. Otal, MD

Department of Radiology

P. Soula, MD; P. Concina, MD

Department of Cardiovascular Surgery

P. Massabuau, MD

Department of Cardiology

M. Mazerolles, MD

Intensive Care Unit Centre Hospitalier Universitaire, Hôpital de Rangueil, Toulouse, France

B. Bui, MD

Department of Radiology Centre Hospitalier de l’Université de Montréal, Campus Saint-Luc, Montréal (Québec), Canada