Reverse-Wire TEVAR for Subacute Type B Aortic Dissection with Severe True-Lumen Collapse: A Case Report

Type B aortic dissection (TBAD) requires management tailored to the disease phase and clinical presentation, with the subacute period representing a favorable window for endovascular intervention due to improved procedural safety and remodeling potential. We report the case of a 38-year-old male with hypertension, dyslipidemia, and bicuspid aortic valve disease who presented one month after symptom onset with persistent chest pain and progressive bilateral lower-limb numbness. Clinical examination suggested early spinal cord ischemia, while laboratory tests demonstrated acute hepatic and renal dysfunction. CT angiography revealed a subacute TBAD with a markedly expanded false lumen and near-complete compression of the true lumen, resulting in visceral, renal, and potential spinal malperfusion. Given the high-risk anatomy and evolving organ dysfunction, a staged hybrid strategy was undertaken. A left carotid-subclavian bypass was performed to secure proximal landing for endovascular repair, followed the next day by thoracic endovascular aortic repair (TEVAR) using two thoracic stent grafts. Postoperative recovery was favorable, with rapid resolution of neurological symptoms and normalization of hepatic and renal parameters, allowing discharge on postoperative day seven. This case underscores the importance of early recognition of malperfusion and timely hybrid intervention in subacute TBAD with severely compressed true lumen, demonstrating excellent early clinical outcomes.