Outcomes of thoracic endovascular aortic repair for penetrating aortic ulcers involving the left subclavian artery with the Castor single-branched stent graft.

Objects: To acquire adequate proximal landing zones for penetrating aortic ulcers in the proximal descending aorta or aortic arch, the left subclavian artery (LSA) is usually covered during thoracic endovascular aortic repair. The Castor single-branched stent graft is used to treat aortic disease involving LSA. Our goal was to evaluate the efficiency and safety of the Castor device in treating penetrating aortic ulcers (PAUs) involving the LSA.

Methods: Between January 2019 and December 2020, we enrolled 25 patients with PAUs requiring LSA revascularization using Castor devices during thoracic endovascular aortic repair (TEVAR). Outcomes including surgical results, 30-day and follow-up deaths and morbidity and aortic computed tomography angiography data were analyzed.

Results: In total, 24 patients (96.0%) underwent successful surgical procedures: 1 patient (4.0%) had a type I endoleak and 1 patient (4.0%) had a stroke. Stent migration occurred in 1 patient (4.0%) and paraplegia in 1 patient (4.0%). Two stents were deployed in 2 patients (8.0%). After a mean follow-up period of 15.7 months, 2 cases of branch occlusions and 1 death related to myocardial infarction were noted. Aortic computed tomography angiography demonstrated that the diameters and depths were reduced significantly whereas complete thrombosis of the lumens of the PAUs occurred in all cases during the 12-months follow-up period.

Conclusions: These preliminary results justify the efficiency and safety of the Castor single branched stent graft in the treatment of PAUs requiring LSA revascularization.