Early Outcome Of The Treatment Of Stanford B Dissection With Castorbranched Aortic Stent Graft System
Minxin Wei, Zanxin Wang, Xianmian Zhuang, Gang Li.
Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, P. R. China., Shenzhen, China.
Background: Thoracic endovascular aortic repair (TEVAR) for the treatment of aortic dissection has experienced rapid development and been widely accepted in the past 20 years. However, there still does not exist a stent graft especially designed for aortic arch, which can reconstruct the supra-arch vessels. Castor branched aortic stent graft system, has obtained the regulatory approval from China Food and Drug Administration (CFDA). It is globally the first branched stent graft especially designed for the aortic arch, with the single branch extending into the left subclavian artery. The present research was to evaluate the early results of Castor in complicated Stanford B dissection. Methods: Fifteen consecutive patients who underwent TEVAR with Castor branched aortic stent graft system were retrospectively reviewed from Jun 2017 to Dec 2018. Indications were acute B dissection (n = 12), complicated type B dissection with retrograde dissection involving the mid-arch (n = 1), mid-arch aneurysms of the inner arch curvature (n = 2). Peri -operative clinical data were recorded. Following up time was 2-12 months. Results: The median patient age was 56 (range, 46 -83) years old, and 14 of the 15 patients were male. There was no death, stroke, spinal cord injury or retrograde type A dissection happened. All the cases were deployed MicroPort Castor stent. Mean operation time was 112 (range, 108 -143) minutes. Mean duration of hospital stay was 7 ±3 days (range, 3-10 days). Only one branch of the Castor stent was put into the left common carotid. Because the arch aneurysm was just near the left subclavian artery, which had to be occluded to protect the type I endoleak. During follow up, no postoperative complications occurred, all target vessels remained patent and no stent-related type I or type IIIendoleak. Conclusions: Castor branched aortic stent graft system could be a good alternative for patients with type B dissection encroaching into the left subclavian artery or the original tear located within 20mm distal to the left subclavian artery and 15mm distal to the left carotid artery. It could effectively avoid type III endoleak and long-term migration.
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