# Outcomes of Castor single-branched stent graft combined with in situ fenestration left subclavian artery in aortic arch disease: a single-center experience

## TL;DR

This study shows that using a specific stent graft with a special technique is safe and effective for treating aortic arch diseases.

## Contribution

The study introduces a novel approach combining a single-branched stent graft with in situ fenestration for aortic arch disease.

## Key findings

- The technical success rate of the procedure was 96.7% with no mortality or major complications in 30 days.
- Subclavian artery patency was 96.6% and carotid artery patency was 100% at follow-up.

## Abstract

To evaluate outcomes of Castor single-branched stent graft combined with in situ fenestration of the left subclavian artery for aortic arch disease.

A retrospective analysis of 30 patients undergoing TEVAR with Castor stent that was first implanted with the branch in the left common carotid artery (LCCA) followed by in situ fenestration of the left subclavian (LSA) between March 2022 and March 2024 was conducted. Perioperative and follow-up data were collected and analyzed.

The study retrospective analysis of 30 patients comprised 16 (53.3%) with acute type B aortic dissections, 6 (20%) with thoracic aortic aneurysms, 2 (6.7%) with intramural hematoma, and 6 (20%) with penetrating aortic ulceration. The technical success rate was 96.7% (29/30). One patient required carotid-axillary bypass due to subclavian artery lateral wall opening. There were no cases of mortality, stroke, upper limb ischemia, paraplegia, or stent graft-induced new entry within the 30-day follow-up period. Median hospitalization was 11 (IQR, 9–14) days, with a median follow-up of 12 (IQR, 8–19) months. One patient (3.3%) suffered a fall-related cerebral hemorrhage unrelated to the procedure. Another (3.3%) developed left upper limb ischemia due to stent angulation, corrected with a cover stent. Subclavian artery patency was 96.6% (28/29), and carotid artery patency was 100%. No deaths, endoleaks, or stent migrations occurred.

The Castor stent combined with in situ fenestration is a feasible, effective, and safe strategy for aortic arch disease repair, especially in providing alternative approaches for aortic diseases that require reconstruction in both branches.