Aortic arch stenting: current strategies, new technologies and future directions

Area of Science:

• Cardiovascular Surgery
• Vascular Endovascular Therapy
• Thoracic Aorta Interventions

Background:

• Open aortic arch surgery is complex, associated with significant morbidity and mortality.
• Thoracic endovascular aneurysm repair (TEVAR) has reduced morbidity for descending thoracic aorta treatments.
• Improving outcomes for aortic arch repair necessitates advanced endovascular solutions.

Purpose of the Study:

• To review current open and hybrid repair techniques for the aortic arch.
• To introduce novel endovascular technologies for aortic arch therapy.
• To discuss anatomical and operative considerations for new endovascular devices.

Main Methods:

• Review of current literature on open, hybrid, and endovascular aortic arch repair.
• Discussion of emerging TEVAR devices, including branched and multi-branched designs.
• Analysis of anatomical and technical challenges in aortic arch endovascular interventions.

Main Results:

• Open repair remains a gold standard but carries high risks.
• TEVAR has shown promise for descending thoracic aorta, with new devices emerging for the arch.
• Specific anatomical and operative factors are crucial for successful endovascular arch repair.

Conclusions:

• The future of aortic arch repair likely involves patient-individualized hybrid strategies.
• Multidisciplinary 'thoracic aorta teams' are essential for optimal patient management.
• Combining open and endovascular techniques offers a tailored approach to complex aortic arch cases.