From the Research
The most effective approach to managing suboptimal dissection re-entry technique is to utilize the Complete Entry and Re-entry Neutralization (CERN) protocol, as it significantly improves the rate of favorable remodeling from 25% to 85% (P = 0.0067) 1.
Key Considerations
- The CERN protocol consists of six basic rules: covering all entry tears, amplifying the BMS radial force, using the STABILISE technique, considering the use of thrombus plugs, avoiding stenting of the visceral branches, and sparing the intercostal and lumbar side branches.
- This approach is crucial in minimizing the risk of unfavorable remodeling, which is often associated with uncovered re-entry tears, no relining of dissection membranes, and insufficient coverage of the descending aorta.
- The use of advanced imaging techniques, such as computed tomography, is essential in assessing aortic remodeling after the procedure and identifying potential complications early on.
Recommendations
- In cases of suboptimal dissection re-entry, the CERN protocol should be considered as the primary approach to manage the condition effectively.
- The procedure should be performed by experienced operators with meticulous attention to detail to minimize the risk of complications.
- Patients should be closely monitored post-operatively for any signs of unfavorable remodeling or other complications, and appropriate interventions should be taken promptly if necessary.
Supporting Evidence
- The CERN protocol has been shown to significantly improve the rate of favorable remodeling in patients with aortic dissection, with a 30-day mortality rate of 4.4% 1.
- Other studies have highlighted the importance of proper imaging guidance, device selection, and technique in minimizing the risk of complications during endovascular procedures for aortic dissection 2, 3.
- The use of antiplatelet therapy, such as aspirin, has been shown to be safe and effective in patients with aortic dissection and coronary heart disease who undergo endovascular aortic repair 4.