Outcomes of Zone 1 Thoracic Endovascular Aortic Repair with Single Branched Stent Graft and Left Common Carotid Artery Chimney Stenting for Zone 2 Aortic Arch Pathologies.

Abstract

The aim of this study was to evaluate the safety and efficacy of an innovative, single stage, two target vessel revascularisation endovascular repair strategy, namely single branch and chimney stenting during thoracic endovascular aortic repair (scTEVAR), for zone 2 aortic pathologies requiring proximal sealing in zone 1. This was a retrospective, observational cohort study of consecutive patients who underwent scTEVAR at a tertiary Chinese centre between June 2021 and December 2024. Aortic diameter, centreline distance, tortuosity, and angulation were measured for pre-operative assessment. All procedures adhered to established surgical protocols. Outcomes of interest included technical success, death, stroke, type Ia endoleak, re-intervention, and branch patency. Descriptive statistical analyses were performed using R software. Sixty-six patients (94% men; median age 67 years, interquartile range [IQR] 60, 72) were included. The technical success rate was 91% (60 of 66), with the remaining six patients requiring proximal cuff extension with physician modified fenestration due to intra-operative "sail effect". All additional procedures were successful. Another patient (2%) developed retrograde type A aortic dissection and received emergency surgical repair on the eighth post-operative day. There was no death, stroke, or type Ia endoleak during a median follow up of 22 months (IQR 13, 31). Freedom from re-intervention was 93.8% (95% confidence interval [CI] 88.3 - 99.9%) at both one and three year follow up. The left subclavian artery branch patency rate was 96.8% (95% CI 92.6 - 100.0%) at 1 year and 94.1% (95% CI 87.7 - 100.0%) at 3 years. All left common carotid artery stents remained patent during follow up. scTEVAR is a standardised and clinically effective single stage endovascular arch repair strategy for zone 2 aortic pathologies, which enables two target vessel revascularisations and proximal sealing zone extension to zone 1. Peri-operative and 2 year safety and efficacy profiles in anatomically suitable candidates were satisfactory. Studies with improved design on larger cohorts are required to further confirm its durability and safety profiles.