Midterm Outcomes of Multicenter Castor Single-Branch Stent Graft Use in the Treatment of Thoracic Aortic Diseases

Abstract

Purpose:

The aim of this study was to evaluate the midterm efficacy and safety of a single-branch Castor stent graft in the treatment of thoracic aortic disease.

Materials and Methods:

Clinical data of 106 patients with thoracic aortic disease treated with Castor single-branch stent graft at 3 centers were collected between May 2018 and June 2023. The indicators included technical success, stent-related complication, reintervention, retrograde dissection, endoleak, distal stent graft–induced entry (dSINE), branch patency, and mortality. The outcomes of the Castor stent graft for multibranch reconstruction above the arch was also analyzed.

Results:

The technical success was 98.1% (104/106), while the surgical success was 93.4% (99/106). The reintervention was 2.8% (3/106), consisting of a case of retrograde type A dissection, an endoleak, and a dSINE. The retrograde dissection was 1.9% (2/106), while type I endoleak was 1.9% (2/106). The new dSINE was 2.8% (3/106), and the branch patency rate was 100%. The mortality was 1.9% (2/106). The mean follow-up time was 29.1±17.7 months. The 2-year post-surgery cumulative survival rate was 91.0%±3.1%, while the cumulative branch patency rate was 96.2%±2.2%. In addition, the cumulative freedom from stent-related reintervention rate was 93.2%±2.8%. A comparison showed no significant difference in the stent-related complication, branch patency, endoleak, reintervention, and mortality when the proximal end of the Castor stent graft was anchored to zones 1 or 2 of the aorta.

Conclusion:

Castor single-branch stent graft showed favorable early and midterm outcomes in the treatment of thoracic aortic disease. In addition, it was feasible to combine Castor stent graft with other advanced techniques for multibranch aortic arch reconstruction.

Clinical Impact

The Castor single-branch stent graft was approval by the Chinese Food and Drug Administration in 2017. However, there were few studies on the mid-term outcomes for thoracic aortic disease after launching, which mainly focused on small single-center retrospective study. In the study, we assessed the mid-term outcomes of Castor stent graft through multi-center cases, Castor stent graft combined with other advanced techniques (such as fenestration and hybrid) for multi-branch reconstruction of aortic arch were also conducted. We found Castor single-branch stent graft showed favorable early and mid-term outcomes in the treatment of thoracic aortic disease. Additionally, it was feasible to combine Castor stent graft with other advanced technique for multi-branch aortic arch reconstruction. As an off-the-shelf branched stent graft with a wide range of models, it could be also used in most emergent situation. The Castor stent graft was expected to become more widely used in the future.

Keywords

type B aortic dissection thoracic aortic aneurysm intramural hematoma thoracic endovascular aortic repair single-branch stent castor stent graft

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References

Song

Zhang

, et al. A Chinese expert consensus on thoracic endovascular aortic repair of type B aortic dissection with a single-branched stent graft for revascularization of the left subclavian artery. Front Surg. 2023;10:1230334.

Upchurch

Jr Escobar

Azizzadeh

, et al. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg. 2021;73(1S):55S–83S.

Czerny

Schmidli

Adler

, et al. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg. 2019;55(1):133–162.

Konstantinou

Kölbel

Debus

, et al. Fenestrated versus debranching thoracic endovascular aortic repair for endovascular treatment of distal aortic arch and descending aortic lesions. J Vasc Surg. 2021;73(6):1915–1924.

Canaud

Ziza

Ozdemir

, et al. Outcomes of left subclavian artery transposition for hybrid aortic arch debranching. Ann Vasc Surg. 2017;40:94–97.

İnce Altınay

İL

Huseynov

, et al. Mid-term results of left carotid-subclavian bypass in patients undergoing zone 2 TEVAR. Braz J Cardiovasc Surg. 2022;37(5):721–726.

Zhao

Cui

Yin

, et al. Hybrid operation versus the chimney technique for reconstruction of a single aortic arch branch: a single-centre experience. Interact Cardiovasc Thorac Surg. 2017;25(4):575–581.

Mandigers

de Beaufort

HWL

Smeenk

, et al. Long-term patency of surgical left subclavian artery revascularization. J Vasc Surg. 2022;75(6):1977–1984.

Jing

Feng

, et al. Endovascular repair of aortic dissection involving the left subclavian artery by castor stent graft: a multicentre prospective trial. Eur J Vasc Endovasc Surg. 2020;60(6):854–861.

10.

Oderich

Forbes

Chaer

, et al. Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries. J Vasc Surg. 2021;73(1S):4S–52S.

11.

Lombardi

Hughes

Appoo

, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg. 2020;71(3):723–747.

12.

Huang

Ding

Jiang

, et al. Outcomes of chimney technique for aortic arch diseases: a single-center experience with 226 cases. Clin Interv Aging. 2019;14:1829–1840.

13.

Ding

Liu

Xie

, et al. Outcomes of chimney technique for preservation of the left subclavian artery in type B aortic dissection. Eur J Vasc Endovasc Surg. 2019;57(3):374–381.

14.

Scurto

Peluso

Pascucci

, et al. Type 1A endoleak after TEVAR in the aortic arch: a review of the literature. J Pers Med. 2022;12(8):1279.

15.

Kwiecinski

Cheng

Uberoi

, et al. Thoracic aortic parallel stent-graft behaviour when subjected to radial loading. J Mech Behav Biomed Mater. 2021;118:104407.

16.

Zhang

Zhu

, et al. Off-the-shelf devices for treatment of thoracic aortic diseases: midterm follow-up of TEVAR with chimneys or physician-made fenestrations. J Endovasc Ther. 2020;27(1):132–142.

17.

Shu

Fan

Luo

, et al. Endovascular treatment for aortic arch pathologies: chimney, on-the-table fenestration, and in-situ fenestration techniques. J Thorac Dis. 2020;12(4):1437–1448.

18.

Liu

, et al. Comparison of chimney and fenestrated techniques for supra-aortic branch revascularization during thoracic endovascular aortic repair: a systematic review and meta-analysis. Cardiovasc Intervent Radiol. 2023;46(10):1315–1328.

19.

XiaoHui

Wei

, et al. Comparison of supra-arch in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery. Vascular. 2019;27(2):153–160.

20.

Yao

Chen

Liao

Ding

Qin

Qiao

Sun

Zheng

. Systematic review and meta-analysis of type B aortic dissection involving the left subclavian artery with a Castor stent graft. Front Cardiovasc Med. 2022;9:1052094.

21.

Liu

Qin

Cui

, et al. Endovascular repair of aortic arch intramural hematoma and penetrating ulcers with 810 nm in situ laser-assisted fenestration: preliminary results of a single-center. Lasers Surg Med. 2018;50(8):837–843.

22.

Xiang

Qiu

, et al. A single center experience of in situ needle fenestration of supra-aortic branches during thoracic endovascular aortic repair. Ann Vasc Surg. 2019;61:107–115.

23.

Canaud

Baba

Gandet

, et al. Physician-modified thoracic stent-grafts for the treatment of aortic arch lesions. J Endovasc Ther. 2017;24(4):542–548.

24.

Zhu

Zhao

Dai

, et al. Fenestrated thoracic endovascular aortic repair using physician modified stent grafts for acute type B aortic dissection with unfavourable landing zone. Eur J Vasc Endovasc Surg. 2018;55(2):170–176.

25.

Zhang

, et al. Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies. J Int Med Res. 2020;48(2):300060519870903.

26.

Shang

Tian

, et al. Favourable outcomes of endovascular total aortic arch repair via needle based in situ fenestration at a mean follow-up of 5.4 months. Eur J Vasc Endovasc Surg. 2018;55(3):369–376.

27.

Houérou

Nana

Pernot

, et al. Systematic review on in situ laser fenestrated repair for the endovascular management of aortic arch pathologies. J Clin Med. 2023;12(7):2496.

28.

Katada

Kondo

Tsuboi

, et al. Endovascular total arch repair using in situ fenestration for arch aneurysm and chronic type A dissection. Ann Thorac Surg. 2016;101(2):625–630.

29.

Jayet

Heim

Coggia

, et al. An experimental study of laser in situ fenestration of current aortic endografts. Eur J Vasc Endovasc Surg. 2018;56(1):68–77.

30.

Kopp

Katada

Kondo

, et al. Multicenter analysis of endovascular aortic arch in situ stent-graft fenestrations for aortic arch pathologies. Ann Vasc Surg. 2019;59:36–47.

31.

Chan

Jia

, et al. Methods and clinical outcomes of in situ fenestration for aortic arch revascularization during thoracic endovascular aortic repair. Vascular. 2020;28(4):333–341.

32.

Nana

Tyrrell

Guihaire

, et al. A review: single and multibranch devices for the treatment of aortic arch pathologies with proximal sealing in Ishimaru Zone 0. Ann Vasc Surg. 2023;94:45–55.

33.

Zhao

Zeng

, et al. Mid-term comparison of one-piece branched stent-graft and chimney technique treating aortic arch pathologies. Cardiovasc Intervent Radiol. 2022;45(6):733–743.

34.

Kong

Ruan

, et al. Single-center experience with a unibody single-branched stent graft for zone 2 thoracic endovascular aortic repair. Front Cardiovasc Med. 2022;9:995173.

35.

Luo

Zhang

Huang

, et al. Endovascular repair of aortic pathologies involving the aortic arch using castor stent-graft combined with in-vitro fenestration technology. BMC Cardiovasc Disord. 2023;23(1):107.

36.

Cheng

Liu

. Comparative analysis of endovascular repair of single-branched stent-graft and hybrid procedure for patients with type B acute aortic dissection involving the left subclavian artery. J Endovasc Ther. 2023:15266028221149920.

37.

Wang

Fang

Song

, et al. Short-term follow-up of proximal aorta remodeling after zone 2 thoracic endovascular aortic repair for acute type B aortic dissection. Int J Cardiol. 2023;393:131393.

38.

Tian

Wang

Xie

Mid-term outcomes of left subclavian artery revascularization with Castor stent graft in treatment of type B aortic dissection in left subclavian artery. J Interv Med. 2023;6(2):74–80.

39.

Huang

Jiao

Zhang

, et al. Implantation of unibody single-branched stent graft for patients with type B aortic dissections involving the left subclavian artery: 1-year follow-up outcomes. Cardiovasc Intervent Radiol. 2017;40(11):1678–1686.

40.

Fang

Wang

Liu

, et al. Early outcomes of left subclavian artery revascularization using castor single-branched stent-graft in the treatment of type B aortic dissection or intramural hematoma. Ann Thorac Cardiovasc Surg. 2021;27(4):251–259.

41.

Liang

Dake

Fischbein

, et al. Midterm outcomes of endovascular repair of aortic arch aneurysms with the gore thoracic branch endoprosthesis. Eur J Vasc Endovasc Surg. 2022;64(6):639–645.