Stent misalignment of the Zenith Dissection Endovascular System

The Zenith Dissection Endovascular System is a device designed for treatment of aortic type B dissection utilizing the Provisional ExTension to Induce COmplete ATtachment (PETTICOAT) technique. Due to the stent design (low radial force and lack of columnar support), significant risk of stent misalignment exists, which we have encountered in four out of 25 patients treated since 2005. Misalignment may result from excessive manipulation of the delivery system at the time of implantation or during catheter manipulation during adjunctive or secondary procedures. The manufacturer has modified the design of this device in order to prevent misalignment, although no serious clinical consequences of this misalignment have been reported with a mean follow-up of 50 months. Care with catheter manipulation after device deployment and accurate review of postoperative imaging are still warranted.