Cas cliniques Echec de traitement du collapsus d’un stentgraft thoracique par stent de Palmaz Manuel Pirotte, Valerie Lacroix, Parla Astarci, Jane Nardella, Jean-Christophe Funken, Gebrine El Khoury, Philippe Noirhomme, Robert Verhelst, Bruxelles, Belgique Un stentgraft Gore TAG Excluder a  et ed eploy ee chez une femme de 35 ans pour un an evrysme isthmique sacculaire.  A 12 heures, nous avons diagnostiqu e un collapsus proximal. Un stent de Palmaz a  et e employ e pour rouvrir le segment proximal. Deux mois plus tard, elle s’est pr esent ee avec un accident isch emique transitoire (embolique) li  e  a une apposition sous- optimale du stent de Palmaz dans l’arche aortique distale. Ceci a fait pour ouvrir le rem- placement chirurgical de l’aorte ascendante et de la crosse aortique avec r eimplantation des branches supra-aortiques. La r eouverture d’un collapsus de stentgraft avec un stent de Palmaz peut ^ etre une solution  a court terme ; cependant, sa pr esence peut entraı ˆner des complications emboliques. Traumatic aortic rupture, whether treated conserva- tively or left undiagnosed, can lead to the develop- ment of either late pseudoaneurysms or early aortic rupture. The indications for its treatment have fewer guidelines as compared with atheroma- tous aneurysms. If we rely on previously published data, 1-3 surgical and/or endovascular criteria include rapidly enlarging lesions (increase by 1 cm in 12 months), saccular-type morphology, diameter exceeding twice that of the normal aorta, and pre- sence of symptoms such as pain or signs suggesting compression of surrounding organs (hoarseness, dysphagia). In contrast, a conservative criteria could be an extremely thick and uniform layer of calcium on the imaging examination because it implies an increased wall strength with little propensity to rupture. The location of these pseudoaneurysms, in most cases at the inner curvature of the isthmic region, may render difficulty in their treatment. Surgical exposure and control of the lesion might be also dif- ficult. Regarding the endovascular approach, the difficulty lies in the aorta’s sharp angle and small diameter, frequently encountered in the case of younger patients. The most commonly used stent graft devices are not designed to be placed at this location, and collapses for these stent grafts have been previously described. Deployment of an extra stent graft or placement of a large bare stent in the collapsed stent graft has been reported as a valuable and low morbidity-related procedure in several successful case reports. However, the presence of a rigid bare stent in the distal arch can be thrombo- genic. We report a case of cerebral embolization originating from a Palmaz stent placed in a proxi- mally collapsed thoracic stent graft, treated with open surgical repair. CASE REPORT We report the case of a 35-year-old woman, who deve- loped a saccular isthmic pseudoaneurysm after a fall from the third floor of a building at the age of 24. The patient remained to be asymptomatic; however, in June 2006, she was referred to us by another center after a failed DOI of original article: 10.1016/j.avsg.2010.06.012. Department of Thoracic and Cardiovascular Surgery, Saint-Luc Hospital, Bruxelles, Belgique. Correspondence : Manuel Pirotte, MD, Department of Thoracic and Cardiovascular Surgery, Saint-Luc Hospital, Avenue Hippocrate 10, 1200 Brussels, Belgium, E-mail: manuel.pirotte@gmail.com Ann Vasc Surg 2010; 24: 1137.e13-1137.e19 DOI: 10.1016/j.acvfr.2011.05.021 Ó Annals of Vascular Surgery Inc.  Edit  e par ELSEVIER MASSON SAS 1229.e1