Endovascular management of chronic symptomatic aortic dissection with the Streamliner Multilayer Flow Modulator: Twelve-month outcomes from the global registry

Abstract

The SMFM is an option in management of complex pan-aortic dissection. Results highlight SMFM implantation leads to dissection stabilization with no further aneurysm progression, and no retrograde type A dissection. Thoracic endovascular aneurysm repair by SMFM ensued in freedom from aortic rupture, neurologic stroke, paraplegia and renal failure. Further analysis of the global registry data will inform long-term outcomes.

Aortic Remodeling After Total Endovascular Aortic Repair With Multilayer Stents: Computational Fluid Dynamics Analysis of Aortic Remodeling Over 3 Years of Follow-up

“…4 Multilayer stents modulate blood flow, generating a positive remodeling effect on the dissected vessel. 13 As recently demonstrated by Sultan et al, 9 the flow modulator laminates turbulent flow, reducing damaging peak wall stress, promoting the formation of a physiologic thrombus, and preserving branch patency. The advantage of the MFM is that major collateral branches can be covered and preserved without compromising flow.…”

“…Virtual deployment software was used for preoperative case planning (EndoSize; Therenva SAS, Rennes, France), which is vital to accurate measurement of the size and number of devices that are needed to efficiently cover the entire aorta with appropriate overlapping. 9 As the MFM is approved in the European Union only for aneurysm treatment, emergency exemption for dissection was obtained from the national authority. The patient consented to the publication of this report.…”

Endovascular strategies for post-dissection aortic aneurysm (PDAA)

“…No aortic ruptures or aortic-related deaths were observed. Aortic morphologic remodeling is reflected by a reduction in longitudinal length of the dissected aorta and FL volume [33]. In our experience, the technique was addressed to six cases with degenerative thoracoabdominal aortic aneurysms [34].…”

A clinical review of early outcomes from contemporary flow modulation versus open, fenestrated and branch technologies in the management of thoracoabdominal aortic aneurysm

“…Without the need to selectively cannulate branch vessels, there is much less total fluoroscopy time, less total contrast agent administered and reduced risk of visceral embolisation or branch dissection. 25,[35][36][37][38] The SMFM has shown positive results (Figure 2), but nevertheless there are diverse opinions on its use. Initially, the SMFM was disseminated to the vascular community without the need for ardent operator knowledge, resulting in improper use of the device, and complications have been reported such as device foreshortening upon insertion and subsequent dislocation as a result.…”

“…23,35 The authors have made further recommendations for revision of the SMFM's IFU, which are beyond the scope of this article but have been published by Sultan et al 25 While current literature illustrates that there is a decreased 30-day risk of mortality and associated complications when this new disruptive technology is utilised, there is still a need for prospective, long-term clinical trials, as well as comparative trials to accurately assess long-term outcomes of SMFM treatment that are both precise and reproducible. Positive animal model results, [41][42][43][44][45] in combination with clinical outcomes such as those published recently, 23,[36][37][38] will instill confidence in the wider vascular community for this type of disruptive technology. Without this, the opinion on the SMFM will still remain divided.…”