Application of Castor branched stent combined with parallel stent in Z1 zone thoracic endovascular aortic repair_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: drkongxiang@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 two supra-aortic branches in total endovascular repair of aortic arch lesions. Methods The 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 included, and the perioperative and follow-up data 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 aortic arch 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 follow-up time was 12-15 months. During the follow-up period, all patients survived without stent displacement, type Ⅰa endoleak, parallel stent stenosis and occlusion, or 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.

Citation： KONG Xiang, RUAN Peng, YU Jiquan, GE Jianjun. Application of Castor branched stent combined with parallel stent in Z1 zone thoracic endovascular aortic repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(10): 1473-1477. doi: 10.7507/1007-4848.202308052 Copy

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.	羅明堯, 舒暢, 方坤, 等. "HENDO"技術體系治療主動脈弓部疾病. 中國胸心血管外科臨床雜志, 2020, 27(9): 987-991.Luo MY, Shu C, Fang K, et al. Aortic arch repair by "HENDO" technology clusters. Chin J Clin Thorac Cardiovasc Surg, 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.	李曉曄, 陸清聲. 主動脈弓疾病腔內治療分支重建進展. 中華血管外科雜志, 2021, 6(2): 77-80.Li XY, Lu QS. Endovascular repair of aortic arch pathologies: progress in revascularization of supra-aortic vessels. Chin J Vasc Surg, 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.	張滕, 王世知, 邱結華, 等. 弓部開窗技術保留弓上分支血管的臨床療效. 血管與腔內血管外科雜志, 2021, 7(7): 831-835, 839.Zhang T, Wang SZ, Qiu JH, et al. Clinical effect of arch fenestration technique for preserving supra-aortic branch. J Vasc Endovasc Surg, 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.	王倫常, 舒暢. 非A非B型主動脈夾層的腔內治療. 外科理論與實踐, 2022, 27(4): 294-298.Wang LC, Shu C. Endovascular treatment of non-A non-B aortic dissection. J Surg Concepts Pract, 2022, 27(4): 294-298.
13.	王辰, 龐昕焱. 近端錨定區不足的主動脈弓部疾病腔內修復術中Castor分支支架置入聯合體外預開窗應用觀察. 山東醫藥, 2023, 63(23): 62-64.Wang C, Pang XY. Application of Castor branch stent implantation combined with in vitro fenestration in endovascular repair of aortic arch diseases with insufficient proximal anchoring zone. Shandong Med J, 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. 羅明堯, 舒暢, 方坤, 等. "HENDO"技術體系治療主動脈弓部疾病. 中國胸心血管外科臨床雜志, 2020, 27(9): 987-991.Luo MY, Shu C, Fang K, et al. Aortic arch repair by "HENDO" technology clusters. Chin J Clin Thorac Cardiovasc Surg, 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. 李曉曄, 陸清聲. 主動脈弓疾病腔內治療分支重建進展. 中華血管外科雜志, 2021, 6(2): 77-80.Li XY, Lu QS. Endovascular repair of aortic arch pathologies: progress in revascularization of supra-aortic vessels. Chin J Vasc Surg, 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. 張滕, 王世知, 邱結華, 等. 弓部開窗技術保留弓上分支血管的臨床療效. 血管與腔內血管外科雜志, 2021, 7(7): 831-835, 839.Zhang T, Wang SZ, Qiu JH, et al. Clinical effect of arch fenestration technique for preserving supra-aortic branch. J Vasc Endovasc Surg, 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. 王倫常, 舒暢. 非A非B型主動脈夾層的腔內治療. 外科理論與實踐, 2022, 27(4): 294-298.Wang LC, Shu C. Endovascular treatment of non-A non-B aortic dissection. J Surg Concepts Pract, 2022, 27(4): 294-298.
13. 王辰, 龐昕焱. 近端錨定區不足的主動脈弓部疾病腔內修復術中Castor分支支架置入聯合體外預開窗應用觀察. 山東醫藥, 2023, 63(23): 62-64.Wang C, Pang XY. Application of Castor branch stent implantation combined with in vitro fenestration in endovascular repair of aortic arch diseases with insufficient proximal anchoring zone. Shandong Med J, 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

Application of Castor branched stent combined with parallel stent in Z1 zone thoracic endovascular aortic repair

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