A Surgical Case for Recurrent Embolic Cerebral Infarction after Zone 3 TEVAR for Type B Aortic Dissection
- VernacularTitle:Stanford B型大動脈解離に対するTEVAR術後，SINEに起因する塞栓性脳梗塞を反復しOpen Stent Graft法による上行弓部大動脈置換術を施行して改善した1例
- Author:
Masaya OI
1
;
Ryuji HIGASHITA
1
;
Daijun TOMIMOTO
2
;
Noboru ISHIKAWA
3
Author Information
- Keywords: TEVAR; complication; retrograde embolic stroke; SINE; 4D-MRI
- From:Japanese Journal of Cardiovascular Surgery 2026;55(1):36-40
- CountryJapan
- Language:Japanese
- Abstract: Currently, thoracic endovascular aortic repair (TEVAR) is recommended for type B aortic dissection to reduce long-term aneurysmal progression and lethal aortic events, however, preoperative risk and managements are still unclear. In this report, we present a case of recurrent embolic cerebral infarction associated with stent graft-induced new entry tear (SINE), which required additional surgical treatment. The patient was a 61-year-old male who underwent Zone 3 TEVAR 34 days after the onset of acute type B dissection. Over the course of approximately 1.5 years, he experienced six episodes of recurrent embolic cerebral infarction. A follow-up contrast-enhanced CT scan revealed migration of the stent graft to the distal side and a SINE (stent-induced new entry) in the left subclavian artery distal to the major curvature. Furthermore, a 4D-MRI showed retrograde blood flow from the proximal end of the stent graft extending to the brachiocephalic artery. Therefore, the patient underwent ascending aortic arch replacement with an open stent graft technique. False lumen thrombus caused by SINE in the distal aortic arch has potential risk of repeat cerebral infarction. Early and precise diagnosis, as well as preventive treatment strategies are warranted.
