Thoracic Stent Graft Improves Aortic Aneurysm Repair

A thoracic stent graft system has been developed for minimally invasive treatment of aneurysms of the descending thoracic aorta.

The Talent Thoracic Stent Graft System is a modular, self-expanding prosthesis designed for endoluminal exclusion of aortic aneurysms. It consists of a series of serpentine nickel-titanium (nitinol) stents embedded into woven Dacron fabric; the stents are spaced discontinuously along a full-length nitinol spine. The delivery system is a coaxial sheath with pusher rod and a compliant polyurethane balloon used to maximize attachment to the vascular wall and ensure full expansion throughout the length of the device. The Talent is available in a wide range of diameters, from 22 to 46 mm. This offers physicians multiple options to customize devices for their patients' needs and to treat a wider range of anatomies than with the other available endografts, making thoracic endovascular aortic repair (TEVAR) accessible to an additional 25% of patients. Salient features of the Talent device include the proximal bare-spring (uncovered nitinol stent) and custom manufacturing to fit a wide range of aorto-iliac sizes and configurations, as determined preoperatively by computed-tomographic (CT) imaging and angiography. The Talent Thoracic Stent Graft System is a product of Medtronics (Minneapolis, MN, USA), and has been approved by the U.S. Food and Drug Administration (FDA).

"There are still many patients undiagnosed and in need of treatment for thoracic aortic disease,” said Ronald Fairman, M.D., a professor of surgery and chief of vascular surgery at the University of Pennsylvania Hospital (Philadelphia, USA). "FDA approval of the Talent Thoracic Stent Graft is an important development in physicians' abilities to treat this life-threatening condition. In my own experience, this device offers a superior alternative to open surgery and will allow physicians to perform minimally-invasive thoracic aortic aneurysm repair for a broader population of patients.”

Thoracic aneurysms most often occur in the descending thoracic aorta. Others may appear in the ascending aorta or the aortic arch. The most common cause of a thoracic aortic aneurysm is atherosclerosis. Other risk factors include various connective tissue disorders such as Marfan syndrome, previous dissection of the aorta, high blood pressure, trauma such as falls or motor vehicle accidents, and syphilis. For patients with aneurysms of the ascending aorta or aortic arch, surgery to replace the aorta is recommended if the aneurysm is larger than 5-6 cm. There are two options for patients with aneurysms of the descending thoracic aorta; if the aneurysm is larger than six cm, major surgery is done to replace the aorta with a fabric substitute. Endovascular stenting is a less invasive option.


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