Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis decreased RV dilation, reduced pulmonary hypertension, decreased anatomic thrombus burden, and minimized intracranial hemorrhage in patients with acute massive and submassive PE. (A Prospective, Single-arm, Multi-center Trial of EkoSonic® Endovascular System and Activase for Treatment of Acute Pulmonary Embolism (PE) [SEATTLE II]; NCT01513759).

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wire. After endograft predilation, an Atrium ICAST 8-to 10-mm stent is deployed approximately one-quarter into the lumen and three-quarters into the branch vessel. The endograft portion of the covered stent is then flared and a completion angiogram performed.Results: Six patients (3 men, 3 women), mean age of 50 years, underwent left SCA laser fenestration with TEVAR. All had hypertension, and four (67%) had a history of smoking, hypercholesterolemia, or congestive heart disease. Two patients had Marfan syndrome and two patients had previous aortic root replacement. Five patients had acute dissections, two with an intramural hematoma. One patient had a penetrating aortic ulcer distal to the left SCA after previous ascending aortic repair. Mean aortic size was 43 mm (range, 28-80 mm). Mean contrast volume was 101 Ϯ 51 mL. Mean operative time was 180 Ϯ 38 minutes. Technical success was 83% (n ϭ 5). One fenestration attempt was abandoned secondary to the acute angle of the SCA and a type III aortic arch. The SCA stent in this case was snorkeled into the aorta proximal to the endograft, revascularizing the SCA with no clinical consequences. Mean length of hospital stay was 9 Ϯ 3 days. At the mean follow-up of 5.2 months (range, 1-11 months), all SCA stents were patent with no fenestration-related endoleaks. There were also no fenestration-related complications. One patient underwent aortic root replacement of a retrograde aortic dissection. Mortality for our patient population was zero.Conclusion: In situ retrograde laser fenestration is an innovative, feasible, and effective option for revascularizing the SCA during TEVAR.