STABILISE technique to promote aortic remodeling in acute/subacute type B dissection

Abstract

The goals of treating type B aortic dissections include maintaining or restoring blood supply in cases of organ malperfusion, preventing aortic rupture, promoting aortic remodeling, and preventing disease progression and aneurysmal degeneration. The European Society of Vascular and Endovascular Surgery guidelines recommend endovascular treatment for patients with complicated acute/subacute type B aortic dissections and those failing medical management. Several techniques have been used over the past few decades. Recently, the STABILISE (Stent-Assisted Balloon-Induced Intimal Disruption and Relamination in Aortic Dissection Repair) technique has been proposed to treat type B aortic dissections. This method involves proximal thoracic aortic stent grafting with the deployment of distal bare stents, followed by ballooning to intentionally rupture the intimal lamella, allowing the true lumen to fully expand and resulting in a “single-channeled aorta.” Since its adoption, several authors have reported satisfactory results, demonstrating that the technique is safe and effective, and it could be considered a serious attempt to promote positive aortic remodeling over time. This paper provides an analysis of presurgical preparation and planning, detailed procedural description during surgery, necessary support equipment, and strategies for perioperative management.