Endovascular repair of thoracic aortic disease with isolated left vertebral artery and unfavorable proximal landing zone using fenestrated castor stent-graft

Zhenhua Wang; Changcun Fang; Han Song; Duoliang Wei; Xiangbin Meng; Xiao Bai; Chunxiao Liu; Xin Zhao

doi:10.3389/fcvm.2023.1168180

Endovascular repair of thoracic aortic disease with isolated left vertebral artery and unfavorable proximal landing zone using fenestrated castor stent-graft

Front Cardiovasc Med. 2023 Aug 24:10:1168180. doi: 10.3389/fcvm.2023.1168180. eCollection 2023.

Authors

Zhenhua Wang^#^{1

2}, Changcun Fang^#^{1

2}, Han Song^{1

2}, Duoliang Wei^{1

2}, Xiangbin Meng^{1

2}, Xiao Bai^{1

2}, Chunxiao Liu^{1

2}, Xin Zhao^{1

2}

Affiliations

¹ Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China.
² Institute of Thoracoscopy in Cardiac Surgery, Shandong University.

^# Contributed equally.

Abstract

Objective: The main purpose of this study was to evaluate the safety and efficacy of Castor single-branched stent-graft combined with fenestrated technique in treatment of thoracic aortic disease (TAD) with unfavorable proximal landing area (PLZ) and isolated left vertebral artery (ILVA).

Methods: From January 2018 to March 2022, 8 patients with TAD (6 patients with type B aortic dissections, 1 patient with type B intramural hematomas, and 1 patient with thoracic aortic aneurysm) underwent thoracic endovascular aortic repair with fenestrated Castor stent-graft due to the existence of ILVA and unfavorable PLZ. Demographic characteristics, surgical details, postoperative complications, follow-up and postoperative CTA imaging results were collected and analyzed.

Results: The primary technical success rate was 100%. The mean operation time was 115 min (range, 70-180 min). All the left subclavian arteries (LSAs) and ILVAs of the eight patients were revascularized by fenestrated Castor stent-grafts. During the follow-up period, no deaths and complications were observed. No internal leakage, aortic rupture, retrograde type A dissection were found on computed tomography angiography. All of the LSAs and ILVAs maintained patency without stenosis.

Conclusion: Castor single-branched stent-graft implantation combined with fenestration technique may be safe and feasible for TAD patients with ILVA and unfavorable PLZ.

Keywords: castor single-branched stent-graft; fenestrated technique; isolated left vertebral artery; thoracic aortic disease; unfavorable proximal landing zone.

Grants and funding

This work was supported by the National Natural Science Youth Fund Project [grant number 81500367]; and the clinical research program of Shandong University [grant number 2020SDUCRCC031]. All funding from the two funding bodies were used for research design, data collection, analysis and interpretation.