Initial experience and results of a single-branched TEVAR system in Scandinavia.

Background: Thoracic endovascular aortic repair (TEVAR) often requires landing in zone 1 or 2 thereby compromising flow through the supra-aortic branch vessels. The Castor (Microport Medical, Shanghai, China) single branched TEVAR system has an incorporated side branch allowing treatment of pathologies reaching zone 2 and 3, whilst preserving flow to aortic arch side branches. This study aims to report on the initial experience and short-term results of all Castor cases done in Scandinavia.

Methods: All patients treated with a Castor stent graft in Scandinavia were included in this study. Pre- and postoperative radiologic imaging were examined. Medical journals were investigated. Operative data, technical success, survival, major adverse events and reinterventions were recorded and analyzed retrospectively.

Results: Twenty-three patients received a Castor in four different Scandinavian hospitals and were included in this study. Treated pathology included type B dissection (N.=10), penetrating aortic ulcer (N.=3), degenerative aortic aneurysm (N.=7), infective native aortic aneurysm (N.=1), Lusorian aneurysm (N.=1) and a proximal stent graft induced new entry after a previous TEVAR (N.=1). The Castor was deployed in zone 2 with side branch placement in the left subclavian artery (N.=16) or zone 1 with side branch placement in the left common carotid artery (N.=7). Technical success was achieved in 96% (N.=22). Median follow-up was 359 (147-664) days with a side branch patency of 95%. No major adverse events occurred within 30 days. Two reinterventions were performed during follow-up due to a distal stent graft induced new entry. One patient died from myocardial infarction 92 days after the Castor procedure.

Conclusions: This multicenter retrospective study represents largest contemporary European series. Short-term results and initial experience were good with no peri-operative strokes, spinal cord ischemia or death reported.