Design, evolution, and experience with the candy plug device for endovascular false lumen occlusion of chronic aortic dissections

ABSTRACT

Introduction

The management of the false lumen (FL) when dealing with aortic dissection is a crucial aspect since inducing its thrombosis is necessary in order to achieve aortic remodeling. One of the pitfalls of endovascular treatment of aortic dissection (AD) is retrograde distal FL perfusion and pressurization, which prevents FL thrombosis and thus aortic remodeling, while being associated with aneurysmal degeneration of the FL and poor long-term outcomes.

Areas Covered

Currently, there is no CE/FDA approved device for FL closure, however different techniques and devices have been proposed to overcome this challenge, the most known of which is the Candy Plug (CP). This review aims to describe the CP device, its implantation technique, and the available data in the literature (PubMed, Cochrane, and EMBASE databases; last queried, December 31, 2023).

Expert Opinions

While the treatment of AD remains technically challenging, the use of the CP technique to close any distal FL reperfusion proved to be feasible and safe with excellent rates of both technical and clinical success. Furthermore, recent studies have shown a quick learning curve with this technique.

KEYWORDS:

• Candy plug
• thoracic endovascular aortic repair
• aortic dissection
• false lumen
• entry tear
• distal reperfusion

Article highlights

• The management of the false lumen (FL) when dealing with aortic dissection (AD) is a crucial aspect of the treatment. Inducing its thrombosis is necessary in order to achieve aortic remodeling when dealing with aneurysmal dilatation in chronic AD.

• Different techniques and devices have been proposed to overcome this challenge, the most known of which is the Candy Plug (CP).

• The last (third) CP generation was designed with a self-occluding unstented sleeve at the distal end of the device and recent studies reported the feasibility of the CP III with low morbidity and high rates of aortic remodeling.

• A review of the available literature showed the CP technique to be safe and effective, with low rates of complications and high rates (>95%) of FL positive remodeling or stability at follow-up.

Declaration of interest

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Tilo Kölbel: Consultant, proctoring, IP, royalties, research, and travel grants with Cook Medical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.