Castor stent implantation combined with subclavian artery bypass grafting for the treatment of aortic arch lesions_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Shuchun , JIN Min , ZHOU Qing ,  WANG Dongjin

Department of Cardiac Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, P. R. China;

Corresponding?author：

WANG Dongjin, Email: gldjw@163.com

Keywords：

Branched stent; hybrid surgery; thoracic endovascular aortic repair; subclavian artery bypass grafting

DOI：

10.7507/1007-4848.202312081

Video：

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Objective To explore the short- and mid-term efficacy of Castor single branch aortic stent combined with subclavian artery bypass grafting for the aortic arch lesions. Methods A retrospective analysis of the clinical data of patients with proximal anchor zone insufficiency aortic arch lesions treated with Castor stent combined with subclavian artery bypass grafting at the Department of Cardiac Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from August 2020 to November 2023 was performed. Results A total of 22 patients were included, including 19 males and 3 females, with an average age of (56±16) years. There were 18 patients of aortic dissection and 4 patients of aortic arch tumors. The success rate of surgical technique was 100.0%, and the average postoperative hospital stay for patients was (10±4) days. The median follow-up time was 20 months. During the follow-up period, there were no major complications such as endoleak, paraplegia, cerebral infarction, and renal insufficiency, and all patients had no readmissions. Conclusion For proximal anchor zone insufficiency aortic arch lesions, the treatment method of using a Castor stent branch placed in the left common carotid artery can effectively extend the anchor zone, avoid the huge trauma of open chest surgery, and achieve a good short- and mid-term efficacy.

Citation： LI Shuchun, JIN Min, ZHOU Qing, WANG Dongjin. Castor stent implantation combined with subclavian artery bypass grafting for the treatment of aortic arch lesions. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(12): 1733-1737. doi: 10.7507/1007-4848.202312081 Copy

1.	Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.
2.	曹龍, 郭偉. 主動脈弓部疾病腔內治療的新進展. 中國血管外科雜志(電子版), 2023, 15(1): 1-4.Cao L, Guo W. New advances in endovascular treatment of aortic arch diseases. Chin J Vasc Surg (Electron Ed), 2023, 15(1): 1-4.
3.	國家心血管病專家委員會血管外科專業委員會. 雜交技術治療累及弓部主動脈病變的中國專家共識. 中國循環雜志, 2020, 35(2): 124-130.National Society of Vascular Surgery, China. Chinese expert consensus on hybrid technique on treating thoracic aortic pathologies involving the aortic arch. Chin Cir J, 2020, 35(2): 124-130.
4.	羅明堯, 舒暢, 方坤, 等. "HENDO"技術體系治療主動脈弓部疾病. 中國胸心血管外科臨床雜志, 2020, 27(9): 987-991.Luo MY, Shu C, Fang K, et al. Aortic arch repair by "HENDO" technology clusters. Chin J Clin Thorac Cardiovasc Surg, 2020, 27(9): 987-991.
5.	Huang H, Jiao Y, Zhang Y, et al. Implantation of unibody single-branched stent graft for patients with type B aortic dissections involving the left subclavian artery: 1-year follow-up outcomes. Cardiovasc Intervent Radiol, 2017, 40(11): 1678-1686.
6.	Luo ZR, Zhang JX, Huang ZY, et al. Endovascular repair of aortic pathologies involving the aortic arch using castor stent-graft combined with in-vitro fenestration technology. BMC Cardiovasc Disord, 2023, 23(1): 107.
7.	Li X, Li Q, Zhang W, et al. Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies. J Int Med Res, 2020, 48(2): 300060519870903.
8.	孔祥, 阮鵬, 余繼全, 等. Castor分支支架聯合平行支架技術在Z1區胸主動脈腔內修復術中的應用. 中國胸心血管外科臨床雜志, 2025, 32(10): 1473-1477.Kong X, Ruan P, Yu JQ, et al. Application of Castor branched stent combined with parallel stent in Z1 zone thoracicendovascular aortic repair. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(10): 1473-1477.
9.	Lindblad B, Bin Jabr A, Holst J, et al. Chimney grafts in aortic stent grafting: hazardous or useful technique? Systematic review of current data. Eur J Vasc Endovasc Surg, 2015, 50(6): 722-731.
10.	Holt PJ, Johnson C, Hinchliffe RJ, et al. Outcomes of the endovascular management of aortic arch aneurysm: Implications for management of the left subclavian artery. J Vasc Surg, 2010, 51(6): 1329-1338.
11.	Meyer C, Probst C, Strunk H, et al. Second-generation Amplatzer Vascular Plug (AVP) for the treatment of subsequent subclavian backflow typeⅡendoleak after TEVAR. Cardiovasc Intervent Radiol, 2009, 32(6): 1264-1267.
12.	Iida Y, Ito T, Hayashi S, et al. Repair of acute type B aortic dissection complicated by aortic rupture with debranching thoracic endovascular aortic repair and left subclavian artery occlusion using Amplatzer Vascular PlugⅡ. Ann Vasc Dis, 2015, 8(3): 252-254.
13.	Tuite DJ, Kessel DO, Nicholson AA, et al. Initial clinical experience using the Amplatzer Vascular Plug. Cardiovasc Intervent Radiol, 2007, 30(4): 650-654.
14.	Lopera JE. The Amplatzer Vascular Plug: Review of evolution and current applications. Semin Intervent Radiol, 2015, 32(4): 356-369.
15.	Aboyans V, Bauersachs R, Mazzolai L, et al. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: A consensus document from the ESC Working Group on Aorta and Peripheral Vascular Diseases, the ESC Working Group on Thrombosis, and the ESC Working Group on Cardiovascular Pharmacotherapy. Eur Heart J, 2021, 42(39): 4013-4024.

1. Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.
2. 曹龍, 郭偉. 主動脈弓部疾病腔內治療的新進展. 中國血管外科雜志(電子版), 2023, 15(1): 1-4.Cao L, Guo W. New advances in endovascular treatment of aortic arch diseases. Chin J Vasc Surg (Electron Ed), 2023, 15(1): 1-4.
3. 國家心血管病專家委員會血管外科專業委員會. 雜交技術治療累及弓部主動脈病變的中國專家共識. 中國循環雜志, 2020, 35(2): 124-130.National Society of Vascular Surgery, China. Chinese expert consensus on hybrid technique on treating thoracic aortic pathologies involving the aortic arch. Chin Cir J, 2020, 35(2): 124-130.
4. 羅明堯, 舒暢, 方坤, 等. "HENDO"技術體系治療主動脈弓部疾病. 中國胸心血管外科臨床雜志, 2020, 27(9): 987-991.Luo MY, Shu C, Fang K, et al. Aortic arch repair by "HENDO" technology clusters. Chin J Clin Thorac Cardiovasc Surg, 2020, 27(9): 987-991.
5. Huang H, Jiao Y, Zhang Y, et al. Implantation of unibody single-branched stent graft for patients with type B aortic dissections involving the left subclavian artery: 1-year follow-up outcomes. Cardiovasc Intervent Radiol, 2017, 40(11): 1678-1686.
6. Luo ZR, Zhang JX, Huang ZY, et al. Endovascular repair of aortic pathologies involving the aortic arch using castor stent-graft combined with in-vitro fenestration technology. BMC Cardiovasc Disord, 2023, 23(1): 107.
7. Li X, Li Q, Zhang W, et al. Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies. J Int Med Res, 2020, 48(2): 300060519870903.
8. 孔祥, 阮鵬, 余繼全, 等. Castor分支支架聯合平行支架技術在Z1區胸主動脈腔內修復術中的應用. 中國胸心血管外科臨床雜志, 2025, 32(10): 1473-1477.Kong X, Ruan P, Yu JQ, et al. Application of Castor branched stent combined with parallel stent in Z1 zone thoracicendovascular aortic repair. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(10): 1473-1477.
9. Lindblad B, Bin Jabr A, Holst J, et al. Chimney grafts in aortic stent grafting: hazardous or useful technique? Systematic review of current data. Eur J Vasc Endovasc Surg, 2015, 50(6): 722-731.
10. Holt PJ, Johnson C, Hinchliffe RJ, et al. Outcomes of the endovascular management of aortic arch aneurysm: Implications for management of the left subclavian artery. J Vasc Surg, 2010, 51(6): 1329-1338.
11. Meyer C, Probst C, Strunk H, et al. Second-generation Amplatzer Vascular Plug (AVP) for the treatment of subsequent subclavian backflow typeⅡendoleak after TEVAR. Cardiovasc Intervent Radiol, 2009, 32(6): 1264-1267.
12. Iida Y, Ito T, Hayashi S, et al. Repair of acute type B aortic dissection complicated by aortic rupture with debranching thoracic endovascular aortic repair and left subclavian artery occlusion using Amplatzer Vascular PlugⅡ. Ann Vasc Dis, 2015, 8(3): 252-254.
13. Tuite DJ, Kessel DO, Nicholson AA, et al. Initial clinical experience using the Amplatzer Vascular Plug. Cardiovasc Intervent Radiol, 2007, 30(4): 650-654.
14. Lopera JE. The Amplatzer Vascular Plug: Review of evolution and current applications. Semin Intervent Radiol, 2015, 32(4): 356-369.
15. Aboyans V, Bauersachs R, Mazzolai L, et al. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: A consensus document from the ESC Working Group on Aorta and Peripheral Vascular Diseases, the ESC Working Group on Thrombosis, and the ESC Working Group on Cardiovascular Pharmacotherapy. Eur Heart J, 2021, 42(39): 4013-4024.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Castor stent implantation combined with subclavian artery bypass grafting for the treatment of aortic arch lesions

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