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Total aortic arch stenting – hemodynamical impact of carotid artery perfusion

Department of Cardiovascular Surgery, University Hospital CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland

*Corresponding author. Tel.: +41 276038507; fax: +41 276034669 (after the 30.05.2009 fax: +41 213142278).

E-mail address: Lars.Niclauss{at}CHUV.ch (L. Niclauss).

The aim of this experimental study is to evaluate the feasibility and the outcome of total endovascular stent implantation in the aortic arch. Indications for this operation-technique would be acute or chronic dissection of the aortic arch (non-A–non-B dissection) or type B dissection with retrograde extension. Four pigs were canulated via the distal abdominal aorta and a retrograde placement of a Djumbodis^® arch stent (4–9 cm) was controlled by using intravascular ultrasound and intracardiac ultrasound by the inferior cava vein and under radioscopic control. Cerebral perfusion, by using a flow meter placed on one prepared carotid artery, were controlled before, immediate post-procedural (<1 min), and in the early follow-up after aortic arch stent implantation. During the implantation process, especially during balloon inflation and deflation, mean carotid perfusion decreases slightly. A reactive increase of carotid perfusion after stent placements indicates transitory cerebral hypo-perfusion. Non-covered aortic arch stent implantation is technically feasible and could be a potential treatment option in otherwise inoperable arch dissections. The time required for balloon inflation and deflation causes an important risk of cerebral ischemia. The latter can be reduced by transaxillary perfusion.

Key Words: Aortic arch dissection; Total endovascular procedures; Non-covered aortic arch stent; Cerebral perfusion