Single aortic branch device: the Mona LSA experience

Endovascular treatment of aortic arch pathologies is challenging due to its complex anatomical architecture and the presence of vital collateral branches. This paper aims to provide an overview of the currently available and future endovascular options for these diseases, particularly regarding branched stent-grafts and the Mona LSA device. After discussing the indications for revascularization of supra-aortic trunks in endovascular aortic repair, we present the principles, benefits and drawbacks of the main modern methods to overcome an insufficient proximal landing zone, i.e. hybrid repair with associated surgical bypass, chimney or snorkel grafts, fenestrated stent-grafts and branched stent-grafts. Subsequently, we detail the technical specifications of the two main branched stent-graft devices under study: the Valiant Mona LSA (Medtronic, Santa Rosa, CA, USA) and the W.L. Gore (Flafstaff, AZ, USA) arch branch device. The steps of the deployment procedure are described from examples of branched stent-graft aortic repair of aortic dissection and aneurysm of the left subclavian artery. Finally, available results of the premarket trial on the Mona LSA branched stent-graft device are recalled. Branched stent grafts represent a promising therapeutic option for pathologies of the aortic arch with insufficient proximal landing zone or mandatory revascularization of supra-aortic trunks. Further studies are needed to specify their indications, long-term effectiveness and safety.