Castor支架在主动脉弓病变中重建左颈总动脉的可行性和有效性研究OA北大核心CSTPCD

Background and Aims:Thoracic endovascular aortic repair(TEVAR)has become the preferred method for treating aortic arch lesions.One of the challenges and research directions in TEVAR is reconstructing the supra-aortic branches.The Castor single-branched stent graft is widely used to reconstruct the left subclavian artery during TEVAR.However,its application in reconstructing the left common carotid artery(LCCA)is rarely reported.Therefore,this study investigated the feasibility and efficacy of using the Castor single-branch stent graft to reconstruct the LCCA during TEVAR. Methods:Five patients with aortic arch lesions involving Zone 2 treated in the Department of Vascular Surgery of Weifang People's Hospital from October 2021 to September 2022 were reviewed.All patients were males,aged between 39 and 77 years,with an average age of(59.2±14.08)years.Among them,three had acute Stanford type B aortic dissection,and two had aortic arch aneurysms.Under DSA guidance,all patients underwent TEVAR with the reconstruction of the LCCA using the Castor-integrated branched aortic-covered stent.The surgical-related variables,the incidence of postoperative adverse events,and the occurrence of adverse events and aortic remodeling within a six-month follow-up after the operation were analyzed. Results:All five patients successfully underwent the surgery.The operative time ranged from 168 to 233 min,with an average of(191±19.06)min,and no conversions to thoracotomy were necessary.The LCCA was successfully reconstructed using the Castor single-branched stent in all patients.During the postoperative hospital stay,one patient experienced a stroke but recovered full right upper limb muscle strength(Grade V)with clear consciousness two months after the operation.The other four patients did not experience any all-cause death,stroke,stent migration,dissection recurrence,endoleak,paraplegia,or left upper limb ischemia during hospitalization and follow-up.Six months after surgery,aortic CTA re-examination showed that the Castor single-branched stent was well-positioned,with a significant reduction in the mean aortic diameter at the aortic isthmus and pulmonary artery bifurcation levels compared to preoperative measurements(35.8 mm vs.41.9 mm,P=0.035;31.1 mm vs.36.7 mm,P=0.048).The patency rate of the aortic and branch stents was 100％,with no endoleak,and thrombus formation was observed in the aneurysmal/false lumen. Conclusion:Under strict adherence to indications,the use of the Castor single-branched stent for LCCA reconstruction during TEVAR is safe and feasible.However,its efficacy requires longer follow-up and validation with more cases.