False lumen intervention to promote remodelling and thrombosis—The FLIRT concept in aortic dissection
Xun Yuan MBBS, MMED
Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP United Kingdom
Department of Internal Medicine, Coronary Heart Disease Centre, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037 China
Search for more papers by this authorAndreas Mitsis MD
Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP United Kingdom
Search for more papers by this authorThomas Semple FRCR, MBBS, BSc
Radiology Department, Royal Brompton & Harefield NHS Foundation Trust, London, SW3 6NP United Kingdom
Search for more papers by this authorMireya Castro Verdes MD
Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP United Kingdom
Search for more papers by this authorEsther Cambronero-Cortinas MD, MSc
Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP United Kingdom
Search for more papers by this authorYida Tang MD, PhD
Department of Internal Medicine, Coronary Heart Disease Centre, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037 China
Search for more papers by this authorCorresponding Author
Christoph A. Nienaber MD, PhD
Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP United Kingdom
Correspondence Christoph A. Nienaber. Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP Email: [email protected]Search for more papers by this authorXun Yuan MBBS, MMED
Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP United Kingdom
Department of Internal Medicine, Coronary Heart Disease Centre, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037 China
Search for more papers by this authorAndreas Mitsis MD
Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP United Kingdom
Search for more papers by this authorThomas Semple FRCR, MBBS, BSc
Radiology Department, Royal Brompton & Harefield NHS Foundation Trust, London, SW3 6NP United Kingdom
Search for more papers by this authorMireya Castro Verdes MD
Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP United Kingdom
Search for more papers by this authorEsther Cambronero-Cortinas MD, MSc
Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP United Kingdom
Search for more papers by this authorYida Tang MD, PhD
Department of Internal Medicine, Coronary Heart Disease Centre, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037 China
Search for more papers by this authorCorresponding Author
Christoph A. Nienaber MD, PhD
Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP United Kingdom
Correspondence Christoph A. Nienaber. Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust; Imperial College London, London, SW3 6NP Email: [email protected]Search for more papers by this authorFunding information: Beijing Council of Science and Technology, Grant/Award Number: Z171100000417021, Z171100001017214
Abstract
Objective
Thoracic endovascular aortic repair (TEVAR) has changed the management of aortic dissection by induced remodelling. Beyond reconstructing the true lumen, we describe the concept of False Lumen Intervention to promote Remodelling and Thrombosis (FLIRT) in both type A and B aortic dissection.
Methods
Between 2011 and 2017, 10 patients with aortic dissection (5 type A; 5 type B) underwent FLIRT using a combination of patent foramen ovale (PFO) or atrial septal defect (ASD) occluders, coils and glue. Patients were followed by computed tomography (CT) angiogram prior to, and 6 months following, discharge to evaluate false lumen (FL) thrombosis and aortic remodelling. Outcomes analyzed comprised successful device delivery, completeness of FL thrombosis and aortic remodelling, procedure related complications and mortality.
Results
FLIRT induced aortic remodelling in all cases of proximal dissection, with aortic shrinkage from 63.8 ± 7.5 pre-FLIRT, to 50.2 ± 6.6 mm (P = 0.057) and an increase in true lumen area from 5.8 ± 3.6 to 11.4 ± 2.5 cm2 (P = 0.006). In distal dissection (after previous TEVAR with residual FL flow), FLIRT successfully induced FL thrombosis in 4 of 5 cases at first attempt (1 case required additional coiling of the gutter between left subclavian artery and stent-graft for complete thrombosis). While maximal aortic diameter remained unchanged (55.6 ± 9.1 pre-FLIRT and 54.4 ± 13.7 mm at follow-up), true lumen area increased from 7.8 ± 2.3 pre-procedure, to 10.6 ± 1.5 cm2 at follow-up (P = 0.016), consistent with remodelling.
Conclusion
Interventional FL management, using the FLIRT concept, is feasible in selected cases of aortic dissection, promotes FL thrombosis and induces successful remodelling.
CONFLICT OF INTEREST
No potential conflicts exist for all authors.
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