American Heart Association Comment: Nonsurgical Reconstruction Of Thoracic Aortic Dissection By Stent-Graft Placement

May 19, 1999

Two papers published in the May 19 issue of the New England Journal of Medicine suggest that a nonsurgical technique is safe and effective for treating people with aortic dissection, a condition that begins with a tear injury that progressively expands through the aorta, the large artery carrying blood from the heart to the rest of the body.

Aortic dissection is one of the most dangerous diseases of the aorta. In the U.S., about 10 to 20 cases per million people occur annually. If the condition is left untreated, 36 to 72 percent of patients die within 48 hours of diagnosis, and 62 to 91 percent die within one week.

The nonsurgical technique, catheter-delivered stent-graft placement, involves insertion of a wire mesh tube known as a stent to force open and maintain the opening of the blocked aorta.

Until now, people with aortic dissection have typically been treated with surgery or drugs. However, treatment is often followed by severe complications such as rupture of the aorta and death.

"This nonsurgical technique is currently being used in various medical centers to repair aortic dissections. However, these two studies are significant because they are the first to include a sizeable group of patients and to be conducted in a carefully-controlled, scientific manner with consistent collection of data and reporting of results," says Valentin Fuster, M.D., Ph.D., president of the American Heart Association and director of the Cardiovascular Institute, Mount Sinai Medical Center in New York City.

"In order to realize the full potential benefit of this nonsurgical technique for treating people with life-threatening aortic dissection, physicians must recognize the necessity of it being performed by a multidisciplinary team representing various medical specialties, including excellent imaging technology for visualizing the aorta," adds Fuster.

"Although the early results of the stent treatment are promising, the technique must be tested in additional, carefully controlled studies of larger population groups before it can become a recommended treatment for some types of aortic dissection," Fuster continued.

American Heart Association

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