Early Outcomes of Left Subclavian Artery  Revascularization Using Castor Single-Branched Stent-Graft in the Treatment of Type B Aortic  Dissection or Intramural Hematoma

ObjectiveDespite the rapid development of thoracic endovascular aortic repair (TEVAR), it is still a challenge to maintain the blood flow of the branch arteries above the aortic arch in Stanford type B aortic dissection involving the left subclavian artery (LSA). The Castor stent graft is an integrated, customized, single-branch stent that enables reconstruction of the LSA. The purpose of this systematic review and meta-analysis was to assess the efficacy of the Castor stent graft for type B aortic dissection.Materials and methodsAn extensive electronic literature search (PROSPERO registration number: CRD42022322146) was undertaken to identify all articles published up to August 2022 that described thoracic aortic repair with branch stents in the treatment of type B aortic dissection involving the LSA. The quality of the included studies was analyzed using the MINORS criteria. The primary outcome measures were the technical success rate, early mortality rate, endoleak rate, and 1-year survival rate. The secondary outcome measures were the stroke rate, left upper extremity ischemia rate, and target vessel patency rate.ResultsEleven studies involving 415 patients were eligible for this meta-analysis. The LSA was successfully preserved in all procedures. The technical success rate was 97.5% (95% CI: 0.953–0.991); the intraoperative endoleak rate was 0.1% (95% CI: 0.000–0.012); the intraoperative LSA patency rate was 99.52%; the intraoperative LSA stent deformation and stenosis rate was 0.15% (95% CI: 0.000–0.051); the early type I endoleak rate was 1.6% (95% CI: 0.003–0.035); the 30-day mortality rate was 0.96%; the early reintervention rate was 0.9% (95% CI: 0.000–0.040); and the perioperative stroke rate was 0% (95% CI: 0.000–0.005). The 1-year survival rate was 99.7% (95% CI: 0.976–1.000). The half-year LSA patency rate was 99.3%, the 1-year LSA patency rate was 97.58%, and the 2-year LSA patency rate was 95.23%. During the follow-up period, the leakage rate was 0.3% (95% CI: 0.000–0.017), the incidence of left upper extremity ischemia rate was 0.5% (95% CI: 0.000–0.035), and the deformation and stenosis rate of the LSA stent was 2.2% (95% CI: 0.06–0.046).ConclusionThis meta-analysis shows that endovascular repair of type B aortic dissection using the Castor stent-graft may be technically feasible and effective. However, this conclusion needs to be interpreted with caution, as the quality of evidence for all outcomes is between low and very low.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022322146].

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of type B aortic dissection involving the left subclavian artery with a Castor stent graft

Yao

Chen

Liao

et al. 2022

“…Besides, open surgery can lead to potential local complications, such as irritation of the brachial plexus nerve ( 41 ). In comparison, LSA revascularization using endovascular approaches is in line with the minimally invasive concept of the TEVAR procedure and the technology is well established ( 29 ). Actually, the indications for complete endovascular aortic reconstruction are also expanding ( 51 ).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, we also noticed that almost all perioperative complications showed promising results with single-branched stent during TEVAR, including no occurrence of stroke, spinal cord ischemia, or left arm claudication during the in-hospital period or 30 days after the procedure. Moreover, Fang et al noted that single-branched stent-grafts are simpler to implement than fenestration, suggesting that the method has good feasibility ( 29 ). Limited evidence so far suggests that the method has very promising potential for broader application.…”

Section: Discussionmentioning

confidence: 99%

Comparison of techniques for left subclavian artery preservation during thoracic endovascular aortic repair: A systematic review and single-arm meta-analysis of both endovascular and surgical revascularization

Zhang

Xie

Yuan

et al. 2022

“…Compared to open surgery or hybrid operation, the endovascular treatment is with fewer perioperative complications ( 3 ). In treating these aortic arch lesions, physicians prefer to use several assisted techniques including chimney stents ( 4 , 5 ), in situ ( 6 , 7 ) or in vitro fenestration ( 8 , 9 ), branched stent-graft ( 10 ) according to individual experience and patients' anatomy characteristics. Theoretically, the branched stent graft is the most ideal prosthesis for arch reconstruction purposes, but the shortage of this pattern is that it needs customizing according to a different configuration of the arch.…”

Section: Commentmentioning

confidence: 99%

First-in-Human Implantation of Gutter-Free Design Stent-Graft in in situ Fenestration TEVAR for Aortic Arch Pathology

Shu

Wang

et al. 2022

PurposeTo report the technology and preliminary result of gutter-free design stent-grafted in in situ fenestration thoracic endovascular aortic repair (TEVAR).DescriptionThe gutter-free stent-graft has a nickel-titanium self-expanding skeleton, double polytetrafluoroethylene coating, and an outer-skirt fabric structure (named C-skirt endograft). The outer skirt fabric prevents endoleak from the gutter around the stent graft fenestration. Further, the skirt structure right under the fenestration in the aortic stent graft can function as a fixation of the side-branch artery endograft. These designs have the following advantages, such as: 1) prevention of endoleak; and 2) fixation tightly between the branch and aorta endograft pieces.EvaluationA patient who was diagnosed with an aortic arch aneurysm, combined with localized dissection, has successfully implanted the aortic stent graft and C-skirt endograft for the left subclavian artery. The 6-month follow-up result of the C-skirt in situ fenestration TEVAR is satisfactory without obvious endoleak.ConclusionsThe new gutter-free C-skirt stent graft is being safely and effectively used for aortic arch TEVAR. Long-term evaluation of safety, effectivity, and durability needs to be proven by future multi-center studies.