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:

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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