# A Clinical Case of Aneurysmal Dilatation of the Aortic Arch Distal to the Origin of an Aberrant Right Subclavian Artery Treated with Castor Single-Branch Stent Graft Implantation and Right Carotid-Subclavian Bypass

## TL;DR

A 78-year-old patient with a complex aortic aneurysm near an abnormal artery was successfully treated using a specialized stent graft and a bypass procedure.

## Contribution

Demonstrates the feasibility of using a Castor single-branch stent graft in treating distal aortic arch aneurysms with vascular anomalies.

## Key findings

- A hybrid procedure combining a carotid-to-subclavian bypass and stent graft implantation successfully treated a complex aortic arch aneurysm.
- Plug embolization of the ARSA origin prevented a type II endoleak following stent graft deployment.

## Abstract

Advancements in endovascular stent graft design have enabled the treatment of distal aortic arch pathologies. However, the length of the proximal landing zone remains a limitation, especially with vascular anomalies like an aberrant right subclavian artery (ARSA) posing additional challenges. A 78-year-old patient underwent computed tomography angiography (CTA), which revealed progressive enlargement of a distal aortic arch aneurysm located beyond an ARSA that coursed between the esophagus and trachea. Following evaluation by the multidisciplinary Aortic Team, a hybrid procedure was planned. A right carotid-to-ARSA bypass was performed and a Castor single-branched stent graft (CSBSG) was deployed in the aortic arch with its side branch directed into the left subclavian artery (LSA), thereby covering the origin of the ARSA. To prevent a type II endoleak, plug embolization of the ARSA origin was subsequently performed. CSBSG is a feasible treatment for distal aortic arch aneurysms, even in the presence of vascular anomalies such as ARSA.