Management Of Stent Edge Dissection

A major edge dissection is defined as a dissection ≥60 degrees of the circumference and/or ≥3 mm in length. An additional stent implantation may be considered for a major edge dissection, especially if it is associated with an intra-dissection lumen <90% of the respective proximal or distal reference area.1Stent edge dissections may be covered with an additional stent as illustrated in Figure I or observed without further intervention as seen in Figure II.

1Lancet 2016; 388:2618-28.

       

Figure I. An example of a stent edge dissection (white arrow) measuring to be 127 degrees of the lumen circumference in the cross sectional OCT image and 6.2 mm in length (yellow arrow) as measured in the longitudinal OCT L-mode. The following image demonstrates the same patient post stenting over the stent edge dissection. There is no longer a dissection flap present in the cross sectional OCT image.

Figure II. An example of a small distal stent edge dissection which was less than 60 degrees of the lumen circumference and less than 3 mm. A decision was made that no further intervention was required for this case.

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