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Jing Z, Lu Q, Feng J, Zhou J, Feng R, Zhao Z, Bao J, Jiang W, Zhang X, Shu C, Fu W, Liu C, Guo W, Zhang X, Chen Z, Liu C, Han X. Endovascular Repair of Aortic Dissection Involving the Left Subclavian Artery by Castor Stent Graft: A Multicentre Prospective Trial. Eur J Vasc Endovasc Surg 2020; 60:854-861. [PMID: 33183920 DOI: 10.1016/j.ejvs.2020.08.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The left subclavian artery (LSA) origin can be intentionally covered by stent grafts, to provide adequate proximal landing zones during thoracic endovascular repair for Stanford type B aortic dissections (TBADs). To preserve the LSA, a novel single branched stent graft, named "Castor" was designed and a clinical trial conducted to investigate its suitability. METHODS From April 2013 to March 2015, 73 patients with TBAD were treated by Castor stent grafts at 11 Chinese tertiary hospitals as part of a single arm prospective clinical trial. There were 50 acute (<2 weeks [68.5%]) and 23 chronic aortic dissections (>2 weeks [31.5%]). RESULTS The technical success rate was 97% (n = 71/73). The two failures were caused by occlusion of the branch section of the stent graft. There were four intra-operative endoleaks (two type Ia, two type B from the LSA). The endoleak rate was 5% (n = 4/73). There was one in hospital death and no major complications. The median follow up time was 61 months (range 48-72 months). The mortality was 5% (n = 4/73) within one year and 7% within six years (n = 5/73). Two deaths were of unknown cause and three were not related to the aorta. Two new entry tears were found on the proximal or distal edge of the stent graft and were retreated endovascularly. Six occlusions of the branch section of the Castor stent graft were found, and the follow up patency rate of the branch section was 93% (n = 63/68). Two intra-operative endoleaks were left during follow up and eventually disappeared according to the latest computed tomography angiograms. CONCLUSION For patients with TBADs needing anchoring proximal to the origin of LSA, the Castor single branched stent graft may provide an easily manipulated, safe, and effective endovascular treatment.
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Affiliation(s)
- Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Junmin Bao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Weiliang Jiang
- Department of Vascular Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiwei Zhang
- Department of Vascular Surgery, People's Hospital of Jiangsu Province, Jiangsu, China
| | - Chang Shu
- Department of Vascular Surgery, Second Xiangya Hospital of Central South University, Hunan, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Affiliated Hospital of Fudan University, Shanghai, China
| | - Changjian Liu
- Department of Vascular Surgery, Gulou Affiliated Hospital of Nanjing University, Jiangsu, China
| | - Wei Guo
- Department of Vascular Surgery, General Hospital of the People's Liberation Army, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, People's Affiliated Hospital of Peking University, Beijing, China
| | - Zhong Chen
- Department of Vascular Surgery, Anzhen Affiliated Hospital of Capital Medical University, Beijing, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xinwei Han
- Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
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Yang J, Liu Y, Duan W, Yi D, Yu S, Ma R, Ren J. A feasibility study of total endovascular aortic arch replacement: From stent-graft design to preclinical testing. J Thorac Cardiovasc Surg 2016; 151:1203-12. [DOI: 10.1016/j.jtcvs.2015.10.092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/23/2015] [Accepted: 10/24/2015] [Indexed: 11/26/2022]
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Lu Q, Feng J, Zhou J, Zhao Z, Li H, Teng Z, Jing Z. Endovascular repair by customized branched stent-graft: A promising treatment for chronic aortic dissection involving the arch branches. J Thorac Cardiovasc Surg 2015; 150:1631-8.e5. [DOI: 10.1016/j.jtcvs.2015.08.032] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/30/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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Lu Q, Feng J, Zhou J, Zhao Z, Bao J, Feng R, Yuan L, Feng X, Qu L, Pei Y, Mei Z, Jing Z. Endovascular Repair of Ascending Aortic Dissection. J Am Coll Cardiol 2013; 61:1917-24. [DOI: 10.1016/j.jacc.2012.08.994] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/19/2012] [Accepted: 08/30/2012] [Indexed: 11/24/2022]
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Lin C, Wang L, Lu Q, Li C, Jing Z. Endovascular repair of the aortic arch in pigs by improved double-branched stent grafts. Ann R Coll Surg Engl 2013; 95:134-9. [PMID: 23484997 PMCID: PMC4098580 DOI: 10.1308/003588413x13511609955814] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate the feasibility of total endovascular repair of the aortic arch in pigs using improved integrated double-branched stent grafts. METHODS Improved self-expandable stent grafts with a main body and two integrated branches were prepared for the repair of the aortic arch in six pigs. The feasibility of using these stent grafts was evaluated with arteriography, computed tomography (CT), computed tomography angiography (CTA) and autopsy three months following the procedure. RESULTS The double-branched stent grafts were placed successfully in the aortic arch in all six pigs. All pigs survived for at least three months and their biological behaviour was normal. Arteriography, CTA and animal necropsy revealed good fixation in all cases. Aortic valve function and coronary ostia remained intact, and CT of the head did not detect any lesion of cerebral infarction. CONCLUSIONS Endovascular repair of the aortic arch with an integrated double-branched stent graft is safe and feasible in animal studies.
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Affiliation(s)
- C Lin
- Department of General Surgery, Fuzhou General Hospital, Fuzhou, China
| | - L Wang
- Department of General Surgery, Fuzhou General Hospital, Fuzhou, China
| | - Q Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - C Li
- Department of General Surgery, Fuzhou General Hospital, Fuzhou, China
| | - Z Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
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Melissano G, Tshomba Y, Bertoglio L, Rinaldi E, Chiesa R. Analysis of Stroke after TEVAR Involving the Aortic Arch. Eur J Vasc Endovasc Surg 2012; 43:269-75. [DOI: 10.1016/j.ejvs.2011.12.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 12/08/2011] [Indexed: 11/25/2022]
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