Homemade Candy Plug Using a Zenith Alpha Thoracic Stent-Graft for False Lumen Distal Occlusion in Acute-on-Chronic Type B Aortic Dissection

Abstract

Purpose: To report a candy-plug technique using a Zenith Alpha stent-graft to occlude the distal false lumen in a patient with a complicated chronic type B aortic dissection. Case Report: A 50-year-old male smoker presented with chest pain due to rapidly growing complicated chronic type B aortic dissection. Computed tomography angiography (CTA) showed the dissection extending from distal to the origin of the left subclavian artery (LSA) down to the left femoral artery. There was fusiform aneurysmal dilatation of the proximal descending aorta measuring up to 5.8 cm in diameter. He underwent left carotid–subclavian artery bypass, thoracic endovascular aortic repair with a Zenith Alpha stent-graft, a left common carotid artery chimney, and embolization of the proximal LSA. Serial CTA showed persistent false lumen flow. A decision was made to occlude the distal large false lumen using the candy-plug technique. A 44×125-mm Zenith Alpha stent-graft was used to prepare the candy plug. A gutter leak and a type Ia endoleak were embolized via a left brachial artery approach. At 2.5 years, imaging showed the candy plug in position, no endoleak, and the thrombosed false lumen in the thoracic aorta reduced in size. Conclusion: The candy-plug technique is useful in facilitating complete occlusion of the false lumen in chronic aortic dissection, which avoids an open procedure and the risk of higher morbidity.

Candy-Plug Generation II for False Lumen Occlusion in Chronic Aortic Dissection: Feasibility and Early Results

“…Treatment strategies in chronic aortic dissection should include occlusion of the FL. 4,[8][9][10][11][12] This early experience with the next-generation CP showed that positioning of the device in the FL is feasible, with minimal morbidity and mortality and a high rate of complete FL backflow cessation on the final angiogram and postoperative CTA. Compared with the earlier generation, the CP II is tubular and has no midsection, which creates a longer sealing zone.…”

Endovascular repair for acute aortic syndrome involving the descending aorta

“…Therefore, in 2018, an international, multicenter, non-randomized observational registry was initiated to gather data on patients with acute/ subacute Type B AD treated using the STABILISE technique, and this registry is still ongoing. Additional techniques have been proposed to achieve complete occlusion of the FL during endovascular treatment for aortic dissection (AD), such as the Knickerbocker and Candy-Plug techniques [30,31] . The Knickerbocker technique entails the placement of an oversized tubular stent-graft within the true lumen, followed by the rupture of the dissection membrane using a compliant balloon positioned at the midpoint of the graft.…”

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

“…One such procedure following initial repair of the ascending aorta is the STABILISE technique with stentassisted balloon-induced intimal disruption and relamination of aortic dissection (AD) to improve their long-term outcomes in terms of aortic-related events [203]. Others comprise the use of homemade Candy Plugs [204], Candy Plug II [205,206], Coils and vascular plugs [207]. A systematic review of the literature on the intentional targeted false lumen occlusion after AD of Spanos et al revealed that intentional false lumen occlusion seems to be a feasible less invasive approach after TAAD or TBAD treatment, which is not broadly used [208].…”