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There may be new hope for patients with aortic dissection in the form of "patchwork therapy." Researchers from four medical centers recommended the innovative treatment in two articles in a recent issue of the New England Journal of Medicine. Each cardiologist used a catheter to thread a mesh tube-type stent to the torn wall of the aorta where it covers the damaged area and keeps the artery open, preventing rupture.
The four studies are "promising," accord- ing to Valentin Fuster, MD, president of the American Heart Association and director of the Cardiovascular Institute at Mount Sinai Medical Center in New York City, but "the technique must be tested in additional, carefully controlled studies of larger population groups before it can become a recommended treatment for some types of aortic dissection."
Investigators at Stanford (CA) University School of Medicine and Mie University School of Medicine in Japan treated patients with acute, rapidly worsening dissections in which the death rate is typically high despite immediate surgery.1,2 Three of their 19 stent patients died, a much lower death rate than usual in such cases. Other researchers from hospitals in Germany and Italy treated 24 patients with slower moving aortic dissections that generally can be treated by surgery or drugs. Half had surgery and the other 12 were given the patchwork stents. Four of the patients who had surgery died, while there were no deaths in the stent group.
The major symptom of aortic dissection is abrupt, severe chest pain. Research into its causes has linked the condition to high blood pressure, but more than that has not been determined.
1. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 1999; 340:1,546-1,552.
2. Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 1999; 340:1,539-1,545.