Application of Castor branched stent combined with parallel stent in Z1 zone TEVAR_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 KONG Xiang , RUAN Peng , YU Jiquan , GE Jianjun

Department of Cardiovascular Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, P. R. China;

Corresponding author：

KONG Xiang, Email: drongxiang@ustc.edu.cn

Keywords：

Branched stent; parallel stent; endovascular repair; left common carotid artery; left subclavian artery

DOI：

10.7507/1007-4848.202308052

Video：

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Objective To investigate the short and medium term results of Castor single branched stent combined with parallel stent technique in the reconstruction of supra-aortic branches in total endovascular repair of aortic arch lesions. Methods The clinical data of patients with aortic arch disease who were treated with single-branch stents combined with parallel stents for Z1 anchoring and total endovascular repair from April 2022 to August 2022 in the Department of Cardiovascular Surgery of the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed, and the perioperative and follow-up conditions of the patients were analyzed. Results There were 4 males and 1 female with an average age of 46.2±18.6 years. This study included 1 patient of thoracic aortic aneurysm and 4 patients of acute non-A non-B aortic dissection. The success rate of surgical technique was 100.0%. The operative time was 132.3±45.1 min, the immediate postoperative isolation of lesions was satisfactory, and there were no adverse events and death in perioperative period. The median follow-up time was 13 (11-15) months. During the follow-up period, all patients survived without stent displacement, type Ⅰa endoleak, parallel stent stenosis and occlusion, and no re-operation. Conclusion The short and medium term results of single branched stents combined with parallel stents in total endovascular repair of aortic arch diseases requiring Z1 anchoring is satisfactory.

1.	Kong X, Ruan P, Yu J, 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.
2.	Iba Y, Minatoya K, Matsuda H, et al. Contemporary open aortic arch repair with selective cerebral perfusion in the era of endovascular aortic repair. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S72-S77.
3.	Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.
4.	罗明尧, 舒畅, 方坤, 等. “HENDO”技术体系治疗主动脉弓部疾病. 中国胸心血管外科临床杂志, 2020, 27(9): 987-991.
5.	Kudo T, Kuratani T, Sawa Y, et al. Effectiveness and minimal-invasiveness of Zone 0 landing thoracic endovascular aortic repair using branched endograft. J Clin Med, 2022, 11(23): 6981.
6.	Soares TR, Melo R, Amorim P, et al. Clinical outcomes of aortic arch hybrid repair in a real-world single-center experience. J Vasc Surg, 2020, 72(3): 813-821.
7.	李晓晔, 陆清声. 主动脉弓疾病腔内治疗分支重建进展. 中华血管外科杂志, 2021, 6(2): 77-80.
8.	Tsilimparis N, Law Y, Rohlffs F, et al. Fenestrated endovascular repair for diseases involving the aortic arch. J Vasc Surg, 2020, 71(5): 1464-1471.
9.	Chassin-Trubert L, Gandet T, Lounes Y, et al. Double fenestrated physician-modified stent-grafts for total aortic arch repair in 50 patients. J Vasc Surg, 2021, 73(6): 1898-1905.
10.	张滕, 王世知, 邱结华, 等. 弓部开窗技术保留弓上分支血管的临床疗效. 血管与腔内血管外科杂志, 2021, 7(7): 831-835,839.
11.	Luo M, Fang K, Fan B, et al. Midterm results of retrograde in situ needle fenestration during thoracic endovascular aortic repair of aortic arch pathologies. J Endovasc Ther, 2021, 28(1): 36-43.
12.	王伦常, 舒畅. 非A非B型主动脉夹层的腔内治疗. 外科理论与实践, 2022, 27(4): 294-298.
13.	王辰, 庞昕焱. 近端锚定区不足的主动脉弓部疾病腔内修复术中Castor分支支架置入联合体外预开窗应用观察. 山东医药, 2023, 63(23): 62-64.
14.	Luo ZR, Zhang JX, Huang ZY, 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.
15.	van der Weijde E, Heijmen RH, van Schaik PM, et al. Total endovascular repair of the aortic arch: Initial experience in the Netherlands. Ann Thorac Surg, 2020, 109(6): 1858-1863.
16.	Joseph G, Pillai R, Shukla V, et al. Cerebral protection using percutaneous normothermic bilateral antegrade cerebral perfusion during total arch TEVAR in a patient with shaggy aorta. J Endovasc Ther, 2020, 27(3): 405-413.

1. Kong X, Ruan P, Yu J, 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.
2. Iba Y, Minatoya K, Matsuda H, et al. Contemporary open aortic arch repair with selective cerebral perfusion in the era of endovascular aortic repair. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S72-S77.
3. Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.
4. 罗明尧, 舒畅, 方坤, 等. “HENDO”技术体系治疗主动脉弓部疾病. 中国胸心血管外科临床杂志, 2020, 27(9): 987-991.
5. Kudo T, Kuratani T, Sawa Y, et al. Effectiveness and minimal-invasiveness of Zone 0 landing thoracic endovascular aortic repair using branched endograft. J Clin Med, 2022, 11(23): 6981.
6. Soares TR, Melo R, Amorim P, et al. Clinical outcomes of aortic arch hybrid repair in a real-world single-center experience. J Vasc Surg, 2020, 72(3): 813-821.
7. 李晓晔, 陆清声. 主动脉弓疾病腔内治疗分支重建进展. 中华血管外科杂志, 2021, 6(2): 77-80.
8. Tsilimparis N, Law Y, Rohlffs F, et al. Fenestrated endovascular repair for diseases involving the aortic arch. J Vasc Surg, 2020, 71(5): 1464-1471.
9. Chassin-Trubert L, Gandet T, Lounes Y, et al. Double fenestrated physician-modified stent-grafts for total aortic arch repair in 50 patients. J Vasc Surg, 2021, 73(6): 1898-1905.
10. 张滕, 王世知, 邱结华, 等. 弓部开窗技术保留弓上分支血管的临床疗效. 血管与腔内血管外科杂志, 2021, 7(7): 831-835,839.
11. Luo M, Fang K, Fan B, et al. Midterm results of retrograde in situ needle fenestration during thoracic endovascular aortic repair of aortic arch pathologies. J Endovasc Ther, 2021, 28(1): 36-43.
12. 王伦常, 舒畅. 非A非B型主动脉夹层的腔内治疗. 外科理论与实践, 2022, 27(4): 294-298.
13. 王辰, 庞昕焱. 近端锚定区不足的主动脉弓部疾病腔内修复术中Castor分支支架置入联合体外预开窗应用观察. 山东医药, 2023, 63(23): 62-64.
14. Luo ZR, Zhang JX, Huang ZY, 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.
15. van der Weijde E, Heijmen RH, van Schaik PM, et al. Total endovascular repair of the aortic arch: Initial experience in the Netherlands. Ann Thorac Surg, 2020, 109(6): 1858-1863.
16. Joseph G, Pillai R, Shukla V, et al. Cerebral protection using percutaneous normothermic bilateral antegrade cerebral perfusion during total arch TEVAR in a patient with shaggy aorta. J Endovasc Ther, 2020, 27(3): 405-413.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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