Transcarotid Artery Endovascular Reconstruction of the Aortic Arch by Modified Bifurcated Stent Graft for Stanford Type A Dissection

Abstract

A 40-year-old man with Stanford type B dissection underwent his first endovascular repair (EVAR) in April 2004 by Talent thoracic stent graft. He had an uncomplicated recovery and maintained good blood pressure control. However, a new retrograde dissection appeared in September 2004. The new dissection involved his aortic arch and ascending thoracic aorta to the opening of the coronary arteries. To reconstruct the aortic arch, bypasses between the right common carotid artery (RCCA), left common carotid artery and left subclavian artery were performed before endovascular repair. A modified bifurcated Talent stent graft was deployed from the RCCA to the ascending thoracic aorta with a long limb in the innominate artery and a short limb in the aortic arch. A further two pieces of graft were deployed via the common femoral artery. The ascending thoracic aorta and aortic arch were reconstructed completely by the bifurcated stent graft. The final angiography confirmed that there was good stent graft configuration, normal blood flow, and stable haemodynamics. No endoleak or other major complications were encountered. This result indicated that it is possible to reconstruct the aortic arch with a bifurcated stent graft and could be a new endovascular repair model for complex thoracic aortic aneurysm and dissection.

Endovascular repair of the aortic arch in pigs by improved double-branched stent grafts

“…Furthermore, our stent graft was introduced into the aortic arch through the infrarenal aorta, which is expected to generate less injury than a stent graft introduced through the carotid artery 7 . According to the preoperative arteriography, the mean diameter of the common carotid arteries in these six pigs was 3.41mm (SD: 0.23mm).…”

Trans-Carotid Placement of Balloon Expandable Covered Stent for Unplanned Left Carotid Coverage during Endovascular Repair of Distal Arch Aneurysm

“…1,2 Transcarotid access has been used previously during endovascular repair of aortic arch aneurysms using self-expanding stents and segments of iliac artery endografts, 3,4 both of which require larger bore vascular access and risk injury to the carotid artery. Chimney grafts to the left common carotid artery have acceptable early patency and freedom from proximal type I endoleak.…”

The future of stenting in patients with type A aortic dissection: a systematic review

“…However, despite the increasing numbers of aortic dissection cases, these patients are treated at tertiary specialised centres. [34][35][36][37][38][39][40][41] Whether training in endovascular techniques will be available remains uncertain considering the technical challenges involving the aortic valve, coronary arteries, and brachiocephalic vessels and depends on whether the current category of patients undergoing endovascular repair will all be deemed unfit for open surgical repair.…”