Castor stent implantation combined with subclavian artery bypass grafting for the treatment of aortic arch lesions_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Shuchun , JIN Min , ZHOU Qing ,  WANG Dongjin

1. Department of Cardiac Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210002, P. R. China;

Corresponding author：

WANG Dongjin, Email: gldjw@163.com

Keywords：

Branched stent; hybrid surgery; thoracic endovascular aortic repair; subclavian artery bypass grafting

DOI：

10.7507/1007-4848.202312081

Video：

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Objective To explore the short- and mid-term efficacy of Castor single branch aortic stent combined with subclavian artery bypass grafting for the aortic arch lesions. Methods A retrospective analysis of the clinical data of patients with proximal anchor zone insufficiency aortic arch lesions treated with Castor stent combined with carotid-subclavian bypass at the Department of Cardiac Surgery, Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from August 2020 to November 2023 was performed. Results A total of 22 patients were included, including 19 males and 3 females, with an average age of 56±16 years. There were 18 patients of aortic dissection and 4 patients of aortic arch tumors. The success rate of surgical technique was 100.0%, and the average postoperative hospital stay for patients was 10±4 days. The median follow-up time was 20 months. During the follow-up period, there were no major complications such as endoleak, paraplegia, cerebral infarction, renal insufficiency, etc., and all patients had no readmissions. Conclusion For proximal anchor zone insufficiency aortic arch lesions, the treatment method of using a Castor stent branch placed in the left common carotid artery can effectively extend the anchor zone, avoid the huge trauma of open chest surgery, and achieve good short- and mid-term efficacy.

1.	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.
2.	曹龙, 郭伟. 主动脉弓部疾病腔内治疗的新进展. 中国血管外科杂志(电子版), 2023, 15(1): 1-4.
3.	国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-130.
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.	Huang H, Jiao Y, Zhang Y, et al. Implantation of unibody single-branched stent graft for patients with type B aortic dissections involving the left subclavian artery: 1-year follow-up outcomes. Cardiovasc Intervent Radiol, 2017, 40(11): 1678-1686.
6.	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.
7.	Li X, Li Q, Zhang W, et al. Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies. J Int Med Res, 2020, 48(2): 300060519870903.
8.	孔祥, 阮鹏, 余继全, 等. Castor 分支支架联合平行支架技术在Z1区TEVAR 中的应用. 中国胸心血管外科临床杂志, 2023. [Epub ahead of print]..
9.	Lindblad B, Bin Jabr A, Holst J, et al. Chimney grafts in aortic stent grafting: hazardous or useful technique? Systematic review of current data. Eur J Vasc Endovasc Surg, 2015, 50(6): 722-731.
10.	Holt PJ, Johnson C, Hinchliffe RJ, et al. Outcomes of the endovascular management of aortic arch aneurysm: Implications for management of the left subclavian artery. J Vasc Surg, 2010, 51(6): 1329-1338.
11.	Meyer C, Probst C, Strunk H, et al. Second-generation Amplatzer Vascular Plug (AVP) for the treatment of subsequent subclavian backflow typeⅡendoleak after TEVAR. Cardiovasc Intervent Radiol, 2009, 32(6): 1264-1267.
12.	Iida Y, Ito T, Hayashi S, et al. Repair of acute type B aortic dissection complicated by aortic rupture with debranching thoracic endovascular aortic repair and left subclavian artery occlusion using Amplatzer Vascular PlugⅡ. Ann Vasc Dis, 2015, 8(3): 252-254.
13.	Tuite DJ, Kessel DO, Nicholson AA, et al. Initial clinical experience using the Amplatzer Vascular Plug. Cardiovasc Intervent Radiol, 2007, 30(4): 650-654.
14.	Lopera JE. The Amplatzer Vascular Plug: Review of evolution and current applications. Semin Intervent Radiol, 2015, 32(4): 356-369.
15.	Aboyans V, Bauersachs R, Mazzolai L, et al. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: A consensus document from the ESC Working Group on Aorta and Peripheral Vascular Diseases, the ESC Working Group on Thrombosis, and the ESC Working Group on Cardiovascular Pharmacotherapy. Eur Heart J, 2021, 42(39): 4013-4024.

1. 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.
2. 曹龙, 郭伟. 主动脉弓部疾病腔内治疗的新进展. 中国血管外科杂志(电子版), 2023, 15(1): 1-4.
3. 国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-130.
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. Huang H, Jiao Y, Zhang Y, et al. Implantation of unibody single-branched stent graft for patients with type B aortic dissections involving the left subclavian artery: 1-year follow-up outcomes. Cardiovasc Intervent Radiol, 2017, 40(11): 1678-1686.
6. 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.
7. Li X, Li Q, Zhang W, et al. Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies. J Int Med Res, 2020, 48(2): 300060519870903.
8. 孔祥, 阮鹏, 余继全, 等. Castor 分支支架联合平行支架技术在Z1区TEVAR 中的应用. 中国胸心血管外科临床杂志, 2023. [Epub ahead of print]..
9. Lindblad B, Bin Jabr A, Holst J, et al. Chimney grafts in aortic stent grafting: hazardous or useful technique? Systematic review of current data. Eur J Vasc Endovasc Surg, 2015, 50(6): 722-731.
10. Holt PJ, Johnson C, Hinchliffe RJ, et al. Outcomes of the endovascular management of aortic arch aneurysm: Implications for management of the left subclavian artery. J Vasc Surg, 2010, 51(6): 1329-1338.
11. Meyer C, Probst C, Strunk H, et al. Second-generation Amplatzer Vascular Plug (AVP) for the treatment of subsequent subclavian backflow typeⅡendoleak after TEVAR. Cardiovasc Intervent Radiol, 2009, 32(6): 1264-1267.
12. Iida Y, Ito T, Hayashi S, et al. Repair of acute type B aortic dissection complicated by aortic rupture with debranching thoracic endovascular aortic repair and left subclavian artery occlusion using Amplatzer Vascular PlugⅡ. Ann Vasc Dis, 2015, 8(3): 252-254.
13. Tuite DJ, Kessel DO, Nicholson AA, et al. Initial clinical experience using the Amplatzer Vascular Plug. Cardiovasc Intervent Radiol, 2007, 30(4): 650-654.
14. Lopera JE. The Amplatzer Vascular Plug: Review of evolution and current applications. Semin Intervent Radiol, 2015, 32(4): 356-369.
15. Aboyans V, Bauersachs R, Mazzolai L, et al. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: A consensus document from the ESC Working Group on Aorta and Peripheral Vascular Diseases, the ESC Working Group on Thrombosis, and the ESC Working Group on Cardiovascular Pharmacotherapy. Eur Heart J, 2021, 42(39): 4013-4024.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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