Search Results (268)

Post-dissection thoracoabdominal aortic aneurysm (PD-TAAA) is a late sequela of chronic aortic dissection. Complex endovascular aneurysm repair (EVAR), including fenestrated and branched techniques (F/B-EVAR), enables aneurysm exclusion while preserving visceral perfusion; however, bridging stents are not specifically designed for PD-TAAA and are frequently used off-label. Evidence on bridging stent performance is largely derived from degenerative aneurysm cohorts, and PD-TAAA-specific data remain limited. This study evaluated outcomes of the VBX Stent Graft when used as a bridging stent during F/B-EVAR for PD-TAAA. This retrospective analysis included patients with PD-TAAA from the EMBRACE registry (ClinicalTrials.gov: NCT05143138), a multicenter, single-arm registry with retrospective and prospective components, with all outcomes core-laboratory-adjudicated. Procedural, early (thirty-day), and midterm outcomes at one and three years were assessed. The primary endpoints were all-cause mortality and freedom from target vessel instability, defined as loss of durable target vessel reconstruction. Twenty-one patients (mean age 61.5 years; range, 28–77 years) underwent F/B-EVAR with at least one VBX Stent Graft. In total, 82 visceral arteries were treated, of which 51 were bridged with a VBX Stent Graft. Technical success was 100%. Two serious adverse events occurred perioperatively, one requiring reintervention, with no thirty-day mortality or major adverse events. Freedom from all-cause mortality was 95.2% at one year and 90.5% at three years, with two deaths during follow-up. Freedom from target vessel instability at the patient level was 85.7% at both one and three years (95% CI, 62.0–95.2%). VBX Stent Grafts used as bridging stents during F/B-EVAR for PD-TAAA demonstrated high technical success, low early morbidity and mortality, and acceptable mid-term survival and target vessel stability, supporting their use in this challenging anatomical setting within the limitations of a small PD-TAAA cohort. Full article

Background: Thoracic endovascular aortic repair (TEVAR) is an established minimally invasive approach for selected aortic arch pathologies; however, it is associated with risks including stroke and spinal cord ischemia. Revascularization techniques, such as in situ fenestration (ISF), play a critical role in preserving supra-aortic branch perfusion and reducing neurological complications. Methods: This prospective, single-center observational cohort study enrolled 74 consecutive patients undergoing TEVAR with ISF between October 2017 and September 2023. Data collected included demographics, lesion morphology, procedural details, and clinical outcomes. The primary endpoint was procedural technical success; secondary endpoints included 30-day complications, reintervention rate, and all-cause mortality. Results: Technical success was achieved in 100% of cases (74/74; 95% CI: 95.2–100.0%), defined as successful fenestration creation, patent bridging stent graft without kinking or embolization, absence of Type I or III endoleak on completion angiography, and restored antegrade branch flow. Physician-modified fenestration was combined with ISF-thoracic endovascular aortic repair (TEVAR) in 28.4% (21/74) of cases. At 30-day follow-up, 30-day clinical success (freedom from mortality, reintervention, and procedure-related complications) was achieved in 87.8% (65/74) of patients. No mortality was recorded at 30 days. Treatment-related complications included subclavian branch thrombosis (n = 1, 1.4%), transient ischemic attack (n = 1, 1.4%), and endoleaks (n = 7, 9.5%; including Type Ia, Type II, and Type III), with reintervention required in 6 patients (8.1%) during the follow-up period. Beyond 30 days, three late deaths were documented: one aorta-related death (aneurysm rupture at 9 months), one neurological death (ischemic stroke at 13 months), and one cardiovascular death (myocardial infarction at 60 days post-procedure), yielding a late all-cause mortality rate of 4.1% (3/74). Conclusions: ISF-TEVAR demonstrated a high procedural technical success rate and a low 30-day complication and mortality profile in this single-center prospective series of selected patients treated at an experienced center. These early and mid-term results are encouraging; however, given the single-center, non-comparative design and limited standardized follow-up, broader conclusions regarding durability and comparative effectiveness remain premature. Larger multicenter prospective studies with standardized long-term imaging follow-up are warranted. Full article

Coronary in-stent restenosis (ISR) remains a major contributor to repeat revascularisation despite advances in drug-eluting stent (DES) technology. Its persistence reflects a complex and heterogeneous interplay among mechanical, biological, and procedural factors, and understanding the dominant mechanism in each case is fundamental to effective treatment selection. This narrative review provides a contemporary, mechanism-guided approach to the practical management of coronary ISR. We summarise the definition, incidence, and classification of ISR—including the Mehran, Waksman, and SCAI 2023 time-based frameworks—and outline patient-related, procedural, anatomical, and stent-related risk factors. The pathophysiology of neointimal hyperplasia and neoatherosclerosis is discussed with reference to its clinical implications. Intracoronary imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) is central to ISR characterisation and treatment planning. Current international guidelines support imaging use in ISR management, though it is important to recognise that this recommendation is based largely on observational and surrogate-endpoint data rather than ISR-specific randomised trials demonstrating reductions in hard clinical outcomes, and practical barriers including cost, availability, and operator expertise must be acknowledged. Evidence-based treatment strategies—including drug-coated balloons (DCB), repeat DES implantation, lesion-modifying therapies, vascular brachytherapy, and coronary artery bypass grafting—are reviewed critically with reference to contemporary trial data and their specific clinical applicability. The choice between DCB and repeat DES is addressed with greater nuance, accounting for ISR type (BMS-ISR versus DES-ISR), lesion pattern, stent layering, and bleeding risk. Management considerations in complex subsets—chronic total occlusion ISR, left main ISR, saphenous vein graft ISR, and recurrent ISR—are also addressed. We propose a practical, substrate-driven management framework aligned with the 2024 ESC, 2021 ACC/AHA/SCAI, and 2018 JCS/JSCVS guidelines. Future research priorities include ISR-specific randomised trials with hard clinical endpoints, prospective validation of imaging-guided treatment algorithms, head-to-head comparisons of DCB platforms, and investigation of pharmacological strategies targeting neoatherosclerosis progression. Full article

Polymer coatings are integral to nearly every modern cardiovascular and endovascular device, including drug-eluting stents (DESs) and drug-coated balloons (DCBs), bioabsorbable vascular scaffolds (BVSs), occluders, grafts, and catheter and guidewire hydrophilic surfaces. Persistent complications, including late stent thrombosis, delayed endothelialization, hypersensitivity, and restenosis, show that coatings actively shape biological responses rather than acting as inert drug carriers. Their surface chemistry, drug release kinetics, and degradation behavior are upstream determinants of blood– and tissue–material responses that govern healing and failure. This review frames coating selection as a structure–property–biological response problem. It surveys the major classes of synthetic polymer coatings and the defining surface and bulk properties. This review also examines how composition and architecture control drug release, and traces the interfacial cascade of protein adsorption, coagulation and complement activation, platelet and leukocyte responses, and neutrophil extracellular trap (NET) formation. These mechanisms are linked to contemporary design strategies that improve hemocompatibility, limit thrombosis, promote endothelial recovery, and tune degradation, and to the standardization and translation gaps that remain. The central message is that polymer coatings are not biologically equivalent. Their surface chemistries and degradation profiles determine the thrombo-inflammatory outcomes. Therefore, coating design should be guided by intended biological response, not drug release alone. Full article

Objectives: This study aimed to evaluate the impact of thoracic endovascular aortic repair (TEVAR) on aortic remodeling using CT angiography-based morphometric measurements and to examine associated mid-term clinical outcomes in patients with acute Stanford type B aortic dissection. Methods: This retrospective, single-center observational cohort study included 33 consecutive patients who underwent TEVAR for acute Stanford type B aortic dissection between January 2020 and January 2025. Preoperative and postoperative true lumen (TL), false lumen (FL), and descending aorta (DA) diameters were compared using paired t-tests after Shapiro–Wilk normality testing. Endoleak, reintervention, FL thrombosis, and mortality were analyzed. Univariable analyses identified factors associated with endoleak and reintervention. Spearman’s correlation assessed factors associated with morphometric remodeling response. Results: All 33 patients had acute Stanford type B dissection (mean time to intervention: 2.73 ± 3.86 days). Among 33 patients (81.8% male; mean age 53.6 ± 12.1 years), mean follow-up was 4.08 ± 1.66 years. TEVAR induced a significant aortic remodeling response: TL diameter increased from 9.55 ± 5.91 mm to 28.30 ± 5.49 mm (+18.76 ± 8.83 mm; p < 0.001) and FL diameter decreased from 33.39 ± 6.76 mm to 11.48 ± 8.97 mm (−21.91 ± 9.53 mm; p < 0.001), while DA diameter remained stable (42.94 ± 6.90 vs. 42.03 ± 9.46 mm; p = 0.323). Complete FL thrombosis was achieved in 19 patients (57.6%). Endoleak occurred in nine patients (27.3%); Zone 2 landing was significantly associated with endoleak (54.5% vs. 13.6%, p = 0.033). Secondary intervention was required in 13 patients (39.4%). Overall mortality was 12.1%. Narrower preoperative TL was strongly associated with greater TL expansion (Spearman r = −0.724, p < 0.001); longer stent–graft coverage was associated with greater TL gain (r = +0.522, p = 0.002). Conclusions: TEVAR induced clinically meaningful aortic remodeling in acute Stanford type B dissection without progressive aortic enlargement. A narrower baseline TL and longer stent–graft coverage were associated with greater remodeling benefit. Zone 2 deployment was significantly associated with higher endoleak rates, underscoring the value of careful preprocedural planning and systematic long-term imaging surveillance. Full article

Polyurethane (PU) is widely used in medical products due to its biocompatibility and mechanical properties. Electrospinning (ES) was employed to produce PU-based scaffolds intended for cardiovascular devices (CVD) from blends of Carbothane (Carb) with human serum albumin (HSA), dimethylacetamide (DMA), and drugs. Sirolimus (SRL)—an immunosuppressive/anti-proliferative drug—and diclofenac (DF)—a nonsteroidal anti-inflammatory drug—were introduced into ES blends to produce drug-enriched scaffolds that prevent inflammation and cell overgrowth. The biocompatibility, stability, and mechanical properties of the scaffolds and SRL release were studied. The scaffolds possessed good mechanical properties and were stable in PBS and blood plasma (BP) for 120 days. The minimal SRL release rate was observed for the scaffold 3%Carb/10%HSA/DMA/SRL. A study of scaffold interaction with blood demonstrated good hemocompatibility of most scaffolds. A study of human gingival fibroblasts, endothelial cells (HUVEC and EA.hy926), and vascular smooth muscle cell interaction with scaffolds in vitro demonstrated variability in cell viability and pro-inflammatory interleukin IL-6 secretion, depending on both the scaffold composition and the cell type. The incorporation of DF into scaffolds decreased the concentration of IL-6 in the culture medium. The scaffold 3%Carb/10%HSA/DMA/SRL is the best choice for CVD in terms of hemocompatibility, endothelialization, and the induction of minimal inflammation. Full article

Background/Objectives: the study aims to evaluate early outcomes of endovascular aneurysm repair (EVAR) using the ultra-low-profile Minos^TM Abdominal Aortic Stent-Graft in elective and emergent infrarenal abdominal aortic aneurysm (AAA), and compare its performance with established EVAR devices. Methods: This retrospective single-centre study included 79 patients treated with the Minos stent-graft between September 2020 and August 2024. Primary endpoints were 30-day mortality and major adverse events (MAEs). Secondary outcomes included technical success, endoleak rates, sac dynamics, reintervention rates, and stent-graft patency. Imaging follow-up was performed on day 1, at 4–6 weeks, at 6–12 months, and annually thereafter. Results: The cohort (mean age 74.6 ± 8.2 years; 83.5% male) included 60 elective and 19 emergent cases, with high cardiovascular comorbidity and challenging anatomy (48.1% with iliac diameters < 7 mm and 16.5% < 5 mm; 20.3% hostile necks). Technical success rate was 93.7% (elective: 95.0%; emergent: 89.5%). Persistent endoleaks occurred in 14.0% of patients (type II 12.7%, type I 1.3%). Clinical success was achieved in 88.6% (elective: 90.0%; emergent: 84.2%). Six-month survival was 96.1% in the elective and 89.5% in the emergent cohort. MAEs were more frequent in emergent cases: acute kidney failure (31.6% vs. 3.3%; p = 0.004) and pneumonia (31.6% vs. 0.0%; p < 0.001). Mean follow-up was 12.5 ± 9.9 months (median 9.3). Reinterventions were required in 16.5% within 30 days, more frequently in emergent cases (31.6% vs. 11.7%, p = 0.041). Sac regression ≥5 mm occurred in 43.0%. No stent-graft migrations or infections were reported. Conclusions: Minos demonstrated reliable performance and safety in elective and emergent EVAR with excellent anatomical applicability due to its ultra-low-profile design. Full article

Objective: To investigate the relationship between the aortic arch Tortuosity Index (TI) and post-TEVAR aortic enlargement in patients with type B aortic dissection (TBAD) requiring left subclavian artery (LSA) reconstruction with a single-branched stent-graft. Methods: We retrospectively analyzed 120 patients enrolled in a prospective multicenter clinical trial between December 2020 and November 2021. The aortic arch TI was measured to quantify arch tortuosity. The study evaluated the independent association between TI and the risk of post-TEVAR aortic enlargement using multivariable Cox regression analysis. Furthermore, we estimated enlargement-free survival in patients stratified by TI levels and verified the diagnostic performance of TI for both thoracic and abdominal aortic enlargement. Results: The mean age was 57.0 ± 10.6 years. Multivariable Cox regression revealed TI was independently associated with both thoracic (HR, 3.8; 95% CI, 2.2–6.6; p < 0.001) and abdominal aortic enlargement (HR, 2.5; 95% CI, 1.6–4.1; p < 0.001). Kaplan–Meier survival curves demonstrated that freedom from aortic enlargement was significantly lower in the High-TI group (p < 0.001). ROC curves confirmed excellent discriminative ability for thoracic (AUC: 0.857, 95% CI, 0.775–0.940) and abdominal (AUC: 0.833, 95% CI, 0.756–0.910) enlargement. Conclusions: In TBAD patients requiring LSA reconstruction with a single-branched stent-graft, the aortic arch tortuosity is independently associated with post-TEVAR aortic enlargement. Preoperative measurement of the aortic arch tortuosity contributes to risk stratification in patients with TBAD and may identify those requiring intensified postoperative surveillance. Full article

Background/Objectives: Epidemiological studies over the first decades of the 21st century have reported a decrease in cardiovascular disease (CVD) morbidity and mortality. Changes in coronary care for acute myocardial infarction (AMI) over these years, including the COVID-19 pandemic period, have been less studied in Eastern and Central Europe. The study aimed to assess changes in coronary care—the time of medical assistance and treatment—for AMI patients over 2000–2023 in urban Kaunas residents aged 25–64. Methods: The data source was study cases from the Kaunas Ischemic Heart Disease Registry (Registry)—Kaunas city residents aged 25–64 years included in the Registry according to MONICA project protocol evaluation methodologies. Data were analyzed by sex and age group (25–54 and 55–64 years). Descriptive statistics (chi-square and z-score values) were used to evaluate the data; the significance level was p < 0.05. A logistic regression analysis was performed to assess the odds ratios of death within 28 days across six time periods. Results: The proportion of AMI patients hospitalized up to 2 h from the onset of pain accounted for about one-fifth of all hospitalized patients in 2000–2016, while in 2017–2023, it significantly decreased. In 2017–2023, compared with 2000–2004 and 2009–2016, significantly fewer men who developed AMI were hospitalized within the first 2 h of emergency presentation (p < 0.05). Over the whole study period, fewer women with AMI were hospitalized within the first 2 h of pain as compared to men (p < 0.05). There were no significant differences in time from pain onset to hospitalization between the age groups. At the same time, from 2009 to 2012, more young AMI patients were hospitalized within the first 2 h (p < 0.05). Percutaneous coronary angioplasty (PTCA) with stenting (PCI) increased 30 times from 2000–2004 to 2020–2023. PCI has been the most available treatment for men with AMI since 2009 and stayed stable from 2013 (66.0%) until 2023 (72.1%). Women with AMI tended to get less PCI, PTCA, and coronary artery bypass grafting (CABG) than men. The pre-pandemic and COVID-19 periods did not differ in the proportions of reperfusion treatment methods used in both men and women. Thrombolysis was very rare, and since 2017, it has not been used in Kaunas because PCI has become more accessible. PCI (2000–2016) and CABG (2009–2016) were more prevalent among the 25–54-year-old AMI patients (p < 0.05). From 2017 to 2023, there were no differences between age groups in the reperfusion procedures used, nor were there differences in treatment between these groups during the pre-pandemic (2017–2019) and peri-COVID-19 pandemic (2020–2023) periods. Conclusions: In Kaunas, the treatment of patients with AMI has improved significantly over the past 20 years. The use of PCI has increased greatly, and the rate of CABG surgery stayed stable, while only every fifth patient has been admitted to the hospital in a timely manner. Men were more likely to receive PCI, and older patients were more likely to undergo CABG. Compared to the period of 2000–2004, the chance of dying within 28 days after AMI was significantly lower in 2017. Full article

Objective: To evaluate the feasibility and early outcomes of a curvature-guided strategy that guides dual-branch revascularization during Zone 1 Thoracic Endovascular Aortic Repair (TEVAR) based on whether the aortic pathology is predominantly located on the greater or lesser curvature of the arch. Methods: In this retrospective, descriptive study (February 2023–June 2024), 43 consecutive patients were included under a predefined anatomical protocol. Of these, 3 patients (7.0%) were lost to follow-up and were included in the analysis of baseline characteristics and perioperative outcomes. The remaining 40 patients constituted the per-protocol follow-up cohort. Pathologies predominantly on the aortic arch’s greater curvature (n = 21) were managed with a Castor single-branched stent-graft for the left subclavian artery (LSA) and a left common carotid artery (LCCA) chimney stent. Those on the lesser curvature (n = 22) received a physician-modified endograft (PMEG). The primary outcome was technical success; secondary outcomes included safety, branch patency, and reintervention. Results: The overall technical success rate was 97.7% (100% in the Castor-chimney cohort [21/21] vs. 95.5% in the PMEG cohort [21/22]). No perioperative stroke, spinal cord ischemia, or retrograde type A dissection occurred in either cohort. Two type II endoleaks were observed: one intraoperative in the Castor-chimney cohort and one during follow-up in the PMEG cohort. Among the 40 patients (20 per cohort) who completed a median follow-up of 22.5 months, freedom from aortic-related reintervention was 95% (38/40), with one reintervention occurring in each cohort. Branch patency was 100% (20/20) in the PMEG cohort, whereas it was 95% (one asymptomatic LSA occlusion) in the Castor-chimney cohort. Conclusions: The implementation of a curvature-guided protocol, which rationally matches endograft techniques to arch anatomy, suggests acceptable early safety and efficacy for complex Zone 1 TEVAR. This anatomy-driven framework offers a potential personalized approach to dual-branch revascularization and warrants prospective validation. Full article

Background: Endovascular aortic aneurysm repair (EVAR) is considered the gold standard for the treatment of abdominal aortic aneurysms. However, the performance of stent-grafts used during this procedure may be affected by their structural design, particularly in anatomically challenging, tortuous iliac arteries. This study aimed to evaluate the hemodynamic performance of different stent-graft limb designs in an in vitro EVAR simulation using compliant three-dimensional (3D)-printed iliac artery models with controlled angulations. Methods: Four commercially available stent-grafts (Anaconda^®, Endurant II^®, Treo^®, Zenith Spiral-Z^®) representing different stent-strut configurations (including O-ring, Z-stent, and spiral designs) were deployed in compliant 3D-printed vascular phantoms simulating severe iliac angulations of 75°, 90°, and 105°. The models were incorporated into a pulsatile flow circuit, and pressure and flow velocity were measured proximally and distally to the angulated segment. Results: Across all tested angulations, the O-ring-based design demonstrated the most favorable hemodynamic performance. In particular, the Anaconda stent-graft showed the smallest pressure loss and the lowest increase in distal flow velocity, especially in the 90° and 105° models. These findings suggest that O-ring-supported structures provide greater flexibility and conformability in severely angulated iliac segments. Conclusions: In this controlled in vitro setting, stent-grafts with O-ring strut morphology better preserved flow conditions than other tested configurations in tortuous anatomy. These results suggest that stent-graft structural design may influence device behavior in challenging iliac anatomy under controlled in vitro conditions. These findings should be considered hypothesis-generating bench data and do not represent direct evidence for clinical device selection. Full article

Aspirin has been the default backbone of antiplatelet therapy after percutaneous coronary intervention (PCI) for over two decades, anchored by landmark trials that established 12-month dual antiplatelet therapy (DAPT) as the standard of care. Three developments have prompted reassessment of this paradigm: the markedly lower thrombotic risk of contemporary drug-eluting stents, the greater potency and consistency of potent P2Y₁₂ inhibitors (ticagrelor, prasugrel), and increasing recognition that major bleeding independently worsens outcomes after PCI. Recent randomised trials have systematically tested aspirin withdrawal at varying time points. Immediate aspirin-free strategies (NEO-MINDSET, STOPDAPT-3) demonstrated an early signal of excess ischaemic events in the ACS component of enrolled populations, suggesting that aspirin remains important during the earliest post-PCI period in ACS. One-month strategies (T-PASS, ULTIMATE-DAPT, TARGET-FIRST) and three-month strategies (TWILIGHT, TICO, DUAL-ACS) showed that transition to P2Y₁₂ monotherapy after an initial DAPT period significantly reduces bleeding without increasing ischaemic events in selected populations. Beyond one year, long-term randomised trials including the HOST-EXAM 10-year follow-up (Lancet 2026) and the STOPDAPT-2 5-year landmark analysis (Circ Cardiovasc Interv 2026), together with study-level meta-analyses (PANTHER) and recent individual patient data meta-analyses, provide converging evidence that clopidogrel monotherapy outperforms aspirin for chronic secondary prevention without excess bleeding. The choice of P2Y₁₂ agent is critical: clopidogrel monotherapy in ACS during the first post-procedural year carries excess thrombotic risk owing to CYP2C19 pharmacogenomic variability, whereas ticagrelor and prasugrel provide more reliable protection. This review synthesises the mechanistic rationale, trial evidence across all time points, special clinical contexts (oral anticoagulation, coronary artery bypass grafting, high bleeding risk), guideline evolution, and methodological considerations, providing a practical framework for individualising post-PCI antiplatelet therapy. Full article

Background: Acute portal vein thrombosis (aPVT) is a severe complication of the splanchnic venous system, often associated with portal hypertension, intestinal ischemia, and hepatic dysfunction. Anticoagulation is the first-line therapy but is frequently insufficient in advanced Yerdel grade III–IV cases, where recanalization rates remain low. Endovascular interventions have emerged as alternative therapeutic strategies in selected patients. Methods: We present three cases of patients with Yerdel grade III–IV aPVT who underwent endovascular management. The techniques included: (1) transhepatic aspiration thrombectomy combined with intra-thrombus thrombolysis using alteplase (Actilyse); (2) combined aspiration thrombectomy, intra-thrombus thrombolysis with alteplase, portal vein stenting, and transjugular intrahepatic portosystemic shunt (TIPS) creation; and (3) transsplenic aspiration thrombectomy followed by angioplasty, stent placement, and TIPS creation in a post-liver transplant patient. Results: All procedures were technically successful, achieving complete or near-complete recanalization of the portal venous system. Restoration of patency in the extrahepatic portal circulation was confirmed, and portal pressures were reduced in the TIPS-assisted case. No major periprocedural complications occurred. Clinical outcomes included preservation of transplant candidacy and graft salvage. Conclusions: Endovascular therapy may be an option in selected patients with acute portal vein thrombosis. Careful patient selection and an individualized technical approach are essential. Full article

Background: Femoral pseudoaneurysms are clinically heterogeneous, with substantial variability in anatomical features and patient-related bleeding risk. Standard treatment algorithms may be inadequate, particularly in patients receiving anticoagulation or presenting with altered coagulation profiles. A personalized, risk-adapted interventional strategy may optimize outcomes while preserving procedural safety. This study compares ultrasound-guided compression with endovascular and percutaneous therapies and evaluates the safety of minimally invasive approaches across different risk profiles to support individualized management. Methods: This single-center retrospective cohort study included 65 consecutive patients treated for femoral pseudoaneurysms between January 2019 and May 2025. Treatment modalities comprised ultrasound-guided compression, endovascular embolization (coils, covered stents, NBCA–Lipiodol), percutaneous glue injection, and hybrid approaches. Primary endpoints were technical and clinical success. Safety was assessed using pre- and post-procedural INR, platelet count, and hemoglobin levels. High-risk status was defined as ongoing anticoagulation or antiplatelet therapy, INR > 1.5, or platelet count <50 × 10⁹/L. Results: Endovascular and percutaneous approaches achieved significantly higher technical (100% vs. 68.5%, p = 0.006) and clinical success rates (100% vs. 77.8%, p = 0.009) compared with ultrasound-guided compression. In minimally invasive cohorts, INR and platelet counts remained stable after treatment, while hemoglobin showed an expected post-procedural decrease (p < 0.001). High-risk patients demonstrated technical success rates comparable to standard-risk patients, with no significant differences in laboratory trends. Favorable outcomes were observed across different embolic materials. Conclusions: Endovascular and percutaneous therapies provide superior effectiveness compared with ultrasound-guided compression while maintaining a reassuring safety profile, even in patients at increased bleeding risk. These findings support a personalized, patient-tailored interventional approach based on individual anatomical and clinical characteristics. Full article

Background: Acute type A aortic dissection (ATAAD) is a life-threatening condition that may be complicated by malperfusion, particularly in patients with prior aortic interventions such as Thoracic Endovascular Aortic Repair (TEVAR). Management becomes increasingly complex when the dissection involves supra-aortic branches and compromises previously placed stents. Methods: We report the case of a 58-year-old male presenting with ATAAD and left lower limb paralysis, with a history of prior TEVAR. Imaging demonstrated an entry tear in the ascending aorta with extension into the distal left main and supra-aortic branches, resulting in a dissection flap obstructing the proximal end of the TEVAR stent. The patient underwent emergency surgical intervention including a Bentall procedure, coronary artery bypass grafting (CABG), and deployment of a small Ascyrus Medical Dissection Stent (AMDS) distally within the TEVAR stent. Pre-operatively, the patient had severe lower limb ischemia due to near-complete obstruction of distal flow. Results: Following surgical intervention, there was restoration of true lumen perfusion with resolution of malperfusion. The patient was successfully weaned from cardiopulmonary bypass, extubated on post-operative day 4, and discharged on day 7 with stable hemodynamics and intact bilateral lower limb perfusion. Post-operative computed tomography (CT) demonstrated a well-seated AMDS with no evidence of ongoing false lumen perfusion. At 30-day follow-up, there was no clinical or biochemical evidence of organ malperfusion. Conclusions: The use of an AMDS deployed within a pre-existing TEVAR stent may represent an effective strategy for managing complex ATAAD with malperfusion, particularly in cases requiring combined surgical interventions. Full article