Incidence, Mechanism and Prevention of Stent Graft-induced New Entry Tear (SINE) after TEVAR for Aortic Dissection

Abstract

Stent graft-induced new entry tear (SINE) is one of a significant complication after thoracic endovascular aortic repair (TEVAR) for aortic dissection. Reported incidence of SINE is 4.8–25%, and it is more frequently observed in chronic aortic dissection. Excessive oversizing of the stent graft relative to the true lumen and the sprig back force of the stent graft would contribute to SINE formation. Therefore, it is important to select an appropriate stent graft size based on strict CT measurement of both proximal and distal landing zone, and to place the stent grafts in a way to reduce the aortic wall stress related to spring back force. Using two or more devices in distal to proximal implantation sequence, that usually use distal device with minimal oversizing of the true lumen in descending aorta and proximal device which is selected according to the non-dissected arch diameter, is a useful technique not only to avoid excessive oversizing but also to control the aortic wall stress from the spring back force of the proximal device.