The Zenith Dissection Endovascular System is a device designed for treatment of aortic type B dissection as described by the Provisional ExTension to Induce COmplete ATtachment (PETTICOAT) technique. Since 2005, we have employed this system in 25 cases. We recently reported four cases (16%) of bare metal stent misalignment. Due to stent design (low radial force and lack of columnar support), significant risk of stent misalignment exists; this may result from excessive manipulation of the delivery system or during catheter manipulation during adjunctive or secondary procedure. Despite the absence of clinical consequences (mean follow-up, 49.6 months), the manufacturer modified the design in order to prevent misalignment. Careful catheter manipulation after deployment and accurate review of postoperative imaging are warranted.