CTICasesAcute Retrograde Type A Aortic Dissection due to Stent Graft-Induced New Entry (SINE)
Imaging findings
Prior CT shows a chronic, dilated descending thoracic aortic aneurysm/dissection (type B dissection) with calcified false lumen wall. Post-TEVAR CT (following severe chest pain on the night of stent placement) demonstrates an acute communicating retrograde dissection flap extending into the ascending aorta and root, arising from a new entry tear (SINE) at the proximal landing zone edge of the stent graft.
Key takeaways
Stent graft-induced new entry (SINE) is a known complication of thoracic endovascular aortic repair (TEVAR). While chronic distal SINE is more common (occurring months or years later), acute proximal SINE can manifest as an immediate, life-threatening retrograde Type A dissection extending into the ascending aorta and aortic root, requiring urgent surgical revision.
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