Nana Petroula, Houérou Thomas Le, Guihaire Julien, Gaudin Antoine, Fabre Dominique, Haulon Stéphan
Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, Paris, France.
J Endovasc Ther. 2025 Jun;32(3):802-812. doi: 10.1177/15266028231195758. Epub 2023 Aug 28.
Endovascular aortic arch repair using multibranch devices has been applied in patients considered at high risk for open repair. The aim of this case series was to report the early outcomes in patients managed with a new design 3 branch arch custom-made device, including a retrograde left common carotid artery (LCCA) branch.
The Preferred Reporting Of CaSe Series in Surgery (PROCESS) guidelines were followed. All consecutive patients undergoing endovascular repair of an aortic arch lesion with a custom-made triple-branch device, including a retrograde LCCA branch (Cook Medical, Bloomington, IN, USA), between October 27, 2022, and February 28, 2023, were included. The presence of an arch aneurysm (degenerative or post-dissection) with diameter ≥55 mm and high risk for a conventional open repair set the indication for treatment. The primary outcomes were technical success and mortality at 30 days. Early morbidity and reinterventions were considered as secondary outcomes.
Eight elective patients (87.5% men, mean age 72.3±27.0 years) were included. Five of them (62.5%) had undergone a previous ascending aorta repair of an acute type A aortic dissection. All patients were asymptomatic, except one, with left recurrent laryngeal nerve compression. The mean maximum aortic diameter was 70.4±21.0 mm. Percutaneous femoral and axillary access was used in all cases except three in which a cut down for right carotid access was performed. Technical success was 100%. Femoral access to the LCCA and implantation of the bridging stent was performed without technical challenges. No death nor cerebrovascular event was recorded during the 30 day follow-up. Five patients (62.5%) presented major complications, 3 related to access needing reintervention and the remaining related to congestive heart failure (CHF), which were managed successfully with medical treatment. Follow-up (range 1-4 month) was uneventful, except for one patient who presented a secondary type Ia endoleak.
According to our early experience, the presence of a retrograde branch facilitated the revascularization of the LCCA through femoral access, decreasing the risk of cerebrovascular morbidity. Further analyses with longer follow-up are needed to evaluate the safety and efficacy of the device.Clinical ImpactData arising mainly from the retrograde branch for the revascularization of the LSA are encouraging from a variety of devices. The premiminary experience with a triple-branched arch device, with a retrograde branche for the LSA but also for the LCCA, was associated with no 30 day mortality and 100% technical success.The device's design allowed swift catheterization and completion of the LCCA revascularization using femoral access exclusively.
使用多分支装置进行血管内主动脉弓修复已应用于被认为开放修复风险较高的患者。本病例系列的目的是报告使用一种新设计的三分支主动脉弓定制装置（包括逆行左颈总动脉（LCCA）分支）治疗的患者的早期结果。
遵循外科手术病例系列报告的首选报告（PROCESS）指南。纳入2022年10月27日至2023年2月28日期间所有连续接受定制三分支装置（包括逆行LCCA分支（美国印第安纳州布卢明顿市库克医疗公司））进行血管内修复主动脉弓病变的患者。直径≥55 mm的弓部动脉瘤（退行性或夹层后）的存在以及传统开放修复的高风险确定了治疗指征。主要结局是30天时的技术成功率和死亡率。早期发病率和再次干预被视为次要结局。
纳入8例择期患者（87.5%为男性，平均年龄72.3±27.0岁）。其中5例（62.5%）曾接受过急性A型主动脉夹层的升主动脉修复。除1例左喉返神经受压患者外，所有患者均无症状。主动脉平均最大直径为70.4±21.0 mm。除3例因右颈动脉入路进行切开外，所有病例均采用经皮股动脉和腋动脉入路。技术成功率为100%。经股动脉入路至LCCA并植入桥接支架未遇到技术挑战。30天随访期间未记录死亡或脑血管事件。5例患者（62.5%）出现主要并发症，3例与入路相关需要再次干预，其余与充血性心力衰竭（CHF）相关，经药物治疗成功处理。随访（范围1 - 4个月）期间无异常，除1例患者出现继发性Ia型内漏。
根据我们的早期经验，逆行分支的存在便于通过股动脉入路实现LCCA的血运重建，降低了脑血管发病风险。需要进行更长时间随访的进一步分析以评估该装置的安全性和有效性。临床影响主要来自用于LSA血运重建的逆行分支的各种装置的数据令人鼓舞。一种三分支主动脉弓装置的初步经验，其具有用于LSA但也用于LCCA的逆行分支，与30天无死亡率和100%的技术成功率相关。该装置的设计允许仅使用股动脉入路迅速进行导管插入并完成LCCA血运重建。
