AUTHOR=Pei Yifei , Zhu Hongqiao , Xiao Yu , Zhou Jian , Jing Zaiping 

TITLE=The Mini-Cross Prefenestration for Endovascular Repair of Aortic Arch Pathologies

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.745871

DOI=10.3389/fcvm.2021.745871

ISSN=2297-055X

ABSTRACT=Objective: To examine the feasibility, integrity, efficacy and safety of endovascular repair of the aortic arch pathologies with a mini-cross pre-fenestration (MCPF) on stent-grafts.
Methods: First, to prove the feasibility of MCPF, an in vitro pre-fenestration experiment was conducted. Second, to examine the integrity of the MCPF stent-grafts, a fatigue test was conducted. Then the membranes and metal structures of stent-grafts were examined by light microscopy and scanning electron microscopy (SEM). Third, a clinical experiment was conducted to investigate the efficacy and safety of this novel technique (ClinicalTrials.gov Identifier: NCT04544579). 
Results: All twelve branch stents were successfully implanted and flared in vitro. After the fatigue test stimulating a 5-year cardiac cycle, no obvious disintegration or fracture was found in light microscopy or SEM. From December 2017 to February 2020, 26 patients with left subclavian arteries and/or left common carotid arteries involved received the novel technique. The endovascular repair with the MCPF was successfully performed on all 26 (100%) patients. Eighteen (69.2%) patients underwent the reconstruction of the left subclavian artery (LSCA) only. The fenestrations of both the LSCA and left common carotid artery (LCCA) were conducted in 8 (30.8%) patients. Median operative time was 120 (IQR, 95-137.5) minutes and median revascularization time of LSCA and LCCA was 30.5 (IQR, 22.8-42.0) s and 20.0 (IQR, 18.0-32.0) s separately. During the median follow-up duration of 38.9 (range, 18.8-44.2) months, one case needed an open surgery because of retrograde type A aortic dissection three months after implantation and no other complications or mortality occurred. The maximum aortic diameters were significantly decreased in thoracic aortic dissection and thoracic aortic aneurysm patients (all P<0.05).
Conclusion: The existing evidence demonstrated the safety, rapid branch artery revascularization and positive aortic remodeling of the novel technique. Long-term observation is warranted to prove the durability.