Transseptal guidewire stabilization facilitates stent-graft deployment forpersistent proximal ascending aortic dissection

Purpose: To report endovascular repair of a DeBakey type I ascending aortic dissection. Case Report: Five months after aortocoronary bypass grafting, a 56-year-old woman demonstrated a persistent ascending aortic type I dissection whose e ntry tear proximal to the innominate artery spiraled down the descending th oracic aorta into the iliofemoral arteries. Repair was facilitated with a g uidewire passed through a transseptal sheath in the right femoral vein. The guidewire traversed the right and left atria and the left ventricle and th en exited into the ascending aorta and was exteriorized through the right f emoral artery. A right brachial catheter aided contrast visualization of th e innominate artery. Adenosine-induced elective cardiac arrest promoted pre cise placement of a customized polyester-covered balloon-expandable stent, which closed the aortic rent. Conclusions: A transseptal approach enables the guidewire to follow the cur vature of the aortic arch, providing precise control of the stent-graft del ivery system. This case illustrates the applicability of endovascular techn iques to repair ascending aortic pathologies using readily available techni ques, equipment, and drugs.