Considering these obvious disadvantages of proximal tear only coverage an aortic dissection bare stent system graft (Cook Medical, Bloomington, IN) was introduced with the idea that it can be deployed in the paravisceral seg­ment of the dissected aorta (Fig.21.5). The com­bination with covered stent is known as dissection stent system and has been used in the attempt to increase true lumen of dissected aorta in the tech­nique known as PETICOAT (provisional exten­sion to induce complete attachment) [26, 27]. Unfortunately, the results of such repairs, again, showed high rate of false lumen ow, negative aortic remodeling, and presence of aneurysmal aortic degeneration in up to 63% of treated sub­jects in late period. This in turn lead to a signi­cant number of secondary interventions including late open conversions when thoracoabdominal aneurysmal degeneration occurred (Fig. 21.6) [28, 29].