Li Xiaoye, Fan Jiefu, Zhang Lei, Song Chao, Zhang Hao, Xia Shibo, Li Haiyan, Lu Qingsheng
Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
J Endovasc Ther. 2025 Feb 4:15266028251315015. doi: 10.1177/15266028251315015.
This study evaluated the feasibility and safety of thoracic endovascular aortic repair (TEVAR) for aortic arch penetrating atherosclerotic ulcer (PAU) using Castor single-branched stent-graft with zone 2 landing.
Between May 2020 and April 2022, a total of 25 aortic arch PAU patients were treated by TEVAR with Castor single-branched stent-graft. Outcomes included technical success, perioperative and follow-up morbidity and mortality, and patency of left subclavian artery (LSA).
All patients had aortic arch PAU with intramural hematoma (IMH). The proximal landing zone for all patients was in zone 2, which was between the distal edge of the left common carotid artery and proximal edge of LSA, in all cases. Technical success was achieved in all cases. During hospitalization after the operation, 1 patient died of gastrointestinal bleeding, and 2 patients (8.0%) had ischemic stroke. At a median follow-up of 29 months (interquartile range [IQR], 24-30 months), 2 (8.0%) patients died, including 1 ischemic stroke and 1 hemorrhagic stroke. One patient (4.0%) had reintervention owing to retrograde type A aortic dissection (RTAD) 2 months after the operation, and was successfully treated with aortic root remodeling, ascending aorta and total aortic arch replacement and frozen elephant trunk procedure. No endoleak or LSA occlusion occurred. The maximal diameter of aorta at proximal (30.2±2.4 mm vs 31.2±3.0 mm; p>0.05) and distal (25.7±2.8 mm vs 24.5±2.3 mm; p>0.05) landing zone showed no significant difference before and after the operation.
The TEVAR for aortic arch PAU using Castor single-branched stent-graft is a safe and efficient option with zone 2 landing.
For patients with diagnosis of PAU with IMH, TEVAR with Castor single-branched stent-graft presents low mid-term mortality and morbidity rate, which should be considered as an optimal option when proximal landing zone is insufficient and revascularization of left subclavian artery (LSA) is needed. With Castor single-branched stent-graft, LSA could be revascularized easily and accurately.
本研究评估了使用带2区锚定的Castor单分支覆膜支架进行胸主动脉腔内修复术（TEVAR）治疗主动脉弓穿透性动脉粥样硬化溃疡（PAU）的可行性和安全性。
2020年5月至2022年4月期间，共有25例主动脉弓PAU患者接受了Castor单分支覆膜支架的TEVAR治疗。结果包括技术成功率、围手术期及随访期的发病率和死亡率，以及左锁骨下动脉（LSA）的通畅情况。
所有患者均患有伴有壁内血肿（IMH）的主动脉弓PAU。所有患者的近端锚定区均位于2区，即左颈总动脉远端边缘与LSA近端边缘之间。所有病例均取得技术成功。术后住院期间，1例患者死于消化道出血，2例患者（8.0%）发生缺血性卒中。中位随访29个月（四分位间距[IQR]，24 - 30个月）时，2例患者（8.0%）死亡，包括1例缺血性卒中和1例出血性卒中。1例患者（4.0%）术后2个月因逆行A型主动脉夹层（RTAD）接受再次干预，并成功接受主动脉根部重塑、升主动脉和全主动脉弓置换及象鼻支架植入术。未发生内漏或LSA闭塞。手术前后近端（30.2±2.4 mm vs 31.2±3.0 mm；p>0.05）和远端（25.7±2.8 mm vs 24.5±2.3 mm；p>0.05）锚定区主动脉的最大直径无显著差异。
使用带2区锚定的Castor单分支覆膜支架进行主动脉弓PAU的TEVAR是一种安全有效的选择。
对于诊断为伴有IMH的PAU患者，使用Castor单分支覆膜支架的TEVAR具有较低的中期死亡率和发病率，当近端锚定区不足且需要对左锁骨下动脉（LSA）进行血运重建时，应将其视为最佳选择。使用Castor单分支覆膜支架，可轻松、准确地实现LSA血运重建。
