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Abstract

Objective:

To evaluate the early-term outcomes of endovascular repair for zone 2 aortic arch pathologies using the Castor single-branched stent-graft, with adjunctive chimney technique employed when extending for proximal extension into zones 1 and 0.

Methods:

A single-center retrospective study was conducted on 63 patients (mean age=57.0±13.4 years; 55 males, 87.3%) with zone 2 aortic pathologies treated between February 2023 and June 2024. Proximal landing zones determined treatment strategy: Standard zone 2 landing (n=37, Castor branch in left subclavian artery [LSA]); extended zone 1 landing (n=20, Castor branch in LSA+LCCA chimney); extended zone 0 landing (n=6, Castor branch in LCCA+innominate artery (IA) chimney+selective LSA revascularization based on vertebral artery dominance). Baseline characteristics, procedural data, and outcomes were analyzed to assess technical success, perioperative/follow-up complications, reinterventions, and branch patency. Outcomes were described separately for each landing zone cohort (zones 2, 1, and 0).

Results:

The overall technical success was 96.8% (61/63). No mortality, stroke, paraplegia, retrograde type A aortic dissection/ (RTAAD), endoleak, or upper limb ischemia occurred within the 30-day postoperative period. During a mean follow-up of 17.4±5.5 months, the overall endoleak rate was 1.6% (1/63), comprising a single zone 2 landing type II endoleak (LSA backflow) detected at the 3-month follow-up. No graft-related type I/III endoleaks occurred. Branch occlusion occurred in 1.6% of cases (1/63), involving the Castor LSA branch in a zone 1 landing case at 10 months. All chimney stent-grafts maintained patency. Reinterventions (3.2%, 2/63) comprised: one zone 2 landing type II endoleak, and one zone 1 landing complications (LSA occlusion). All-cause mortality was 1.6% (1/63, occurring at 11 months postoperatively in a zone 1 landing patient due to non-aortic-related causes).

Conclusions:

The Castor single-branched stent-graft enabled effective zone 2 reconstruction. Combined with chimney technique, it facilitated treatment extension into zone 1 and exploratory applications in zone 0. The results for each strategy demonstrate high technical success, a favorable safety profile, high branch/chimney patency rates, and low-complication rates.

Clinical Impact

This study demonstrates that the Castor single-branched stent-graft is safe and effective in endovascular repair of zone 2 aortic arch pathologies. Combined with a chimney stent, its application can be successfully extended to zone 1 and exploratory zone 0 cases. This hybrid strategy provides a minimally invasive endovascular alternative for complex arch pathologies, particularly in patients at high surgical risk or ineligible for custom-made devices. This work contributes by providing the first detailed perioperative and follow-up data for this combined approach, including preliminary technical experience in highly selected zone 0 reconstructions, thereby enriching the evidence base for endovascular arch repair.

Keywords

castor single-branched stent-graft zone 2 aortic pathologies chimney technique proximal zone extension zone 1/0 landing

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References

Rocha

Lindsay

Friedrich

, et al. Systematic review of contemporary outcomes of endovascular and open thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2020;71(4):1396–1412.

Kavanagh

Sultan

Jordan

, et al. Hybrid repair versus conventional open repair for aortic arch dissection. Cochrane Database Syst Rev. 2021;7(7):CD012920.

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.

Yuan

Mitsis

Tang

, et al. The IRAD and beyond: what have we unravelled so far? Gen Thorac Cardiovasc Surg. 2019;67(1):146–153.

DiBartolomeo

Ding

Weaver

, et al. Risk of stroke with thoracic endovascular aortic repair of the aortic arch. Ann Vasc Surg. 2023;97:37–48.

Siddiqui

Farhan

, et al. A meta-analysis on the effect of proximal landing zone location on stroke and mortality in thoracic endovascular aortic repair. J Vasc Surg. 2023;78(6):1559–1566.

Ince

Altinay

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.

Dueppers

Reutersberg

Rancic

, et al. Long-term results of total endovascular repair of arch-involving aortic pathologies using parallel grafts for supra-aortic debranching. J Vasc Surg. 2022;75(3):813–823.

Spath

Campana

Tsilimparis

, et al. Outcomes of fenestrated and branched endografts for partial and total endovascular repair of the aortic arch—a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2024;67(1):106–116.

10.

Fang

Tian

Chen

, et al. Efficacy of endovascular repair using single left common carotid artery stent combined with castor single-branched stent-graft in the treatment of regional diseases of zone 2 of the aorta. J Endovasc Ther. 2024;32:1205–1213.

11.

Zhou

, et al. Thoracic endovascular aortic repair with unibody single-branched stent-graft for type B aortic dissection: a real-world multicenter study. Int J Surg. 2025;111(1):941–949.

12.

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.

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.

, et al. Homemade fenestration and chimney techniques for the left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair. Front Cardiovasc Med. 2023;10:1144751.

16.

McKenna

Vaughan

TJ.

An experimental evaluation of the mechanics of bare and polymer-covered self-expanding wire braided stents. J Mech Behav Biomed Mater. 2020;103:103549. doi:10.1016/j.jmbbm.2019.103549.

17.

Timmins

Miller

Clubb

Jr , et al. Increased artery wall stress post-stenting leads to greater intimal thickening. Lab Invest. 2011;91(6):955–967. doi:10.1038/labinvest.2011.57.

18.

Wang

Shu

, et al. Thoracic endovascular aortic repair with single/double chimney technique for aortic arch pathologies. J Endovasc Ther. 2017;24(3):383–393.

19.

Zhan

Kooperkamp

Lofftus

, et al. Conventional open versus hybrid aortic arch repair: a meta-analysis of propensity-matched studies. J Thorac Dis. 2021;13(8):4714–4722. doi:10.21037/jtd-21-183.

20.

Lei

Chen

, et al. A new process for customized patient-specific aortic stent graft using 3D printing technique. Med Eng Phys. 2020;77:80–87. doi:10.1016/j.medengphy.2019.12.002.

21.

Wang

Huang

Guo

, et al. Application of triple-chimney technique using C-TAG and viabahn or excluder iliac extension in TEVAR treatment of aortic arch dilation diseases. J Thorac Dis. 2018;10(6):3783–3790. doi:10.21037/jtd.2018.06.105.

22.

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. doi:10.1016/j.avsg.2019.02.005.

23.

Chen

Zhang

Liu

, et al. Retrograde type A aortic dissection after thoracic endovascular aortic repair: a systematic review and meta-analysis. J Am Heart Assoc. 2017;6(9):e004649.

24.

Chen

, et al. The outcomes of aortic arch repair between open surgical repair and debranching endovascular hybrid surgical repair: a systematic review and meta-analysis. J Vasc Surg. 2024;79(6):1510–1524. doi:10.1016/j.jvs.2023.12.025.

25.

Arnaoutakis

Scali

Beck

, et al. Comparative outcomes of open, hybrid, and fenestrated branched endovascular repair of extent II and III thoracoabdominal aortic aneurysms. J Vasc Surg. 2020;71(5):1503–1514. doi:10.1016/j.jvs.2019.08.236.

26.

Chan

Masuda

M T L Choong

, et al. A systematic review and meta-analysis of total endovascular versus hybrid repair for the treatment of thoracoabdominal aortic aneurysms. J Vasc Surg. 2024;80(4):1294–1302. doi:10.1016/j.jvs.2023.11.047.

27.

Konstantinou

Debus

Vermeulen

CFW

, et al. Cervical debranching in the endovascular era: a single centre experience. Eur J Vasc Endovasc Surg. 2019;58(1):34–40. doi:10.1016/j.ejvs.2018.12.010.

28.

Gombert

van Issum

Barbati

, et al. Extra-thoracic supra-aortic bypass surgery is safe in thoracic endovascular aortic repair and arterial occlusive disease treatment. Eur J Vasc Endovasc Surg. 2018;55(6):861–866. doi:10.1016/j.ejvs.2018.03.020.

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Early Outcomes of Castor Single-Branched Stent-Graft for Zone 2 Aortic Arch Pathologies and Exploratory Use in Proximal Extension to Zone 1/0 With Chimney Techniques

Abstract

Objective:

Methods:

Results:

Conclusions:

Clinical Impact

Keywords

Get full access to this article

References

Supplementary Material