iCover as bridging stent graft in complex endovascular aortic repair

Background: Bridging Stent Grafts (BSG) are an essential element of fenestrated and branched endovascular aortic repair (FEVAR and BEVAR respectively). Until CE marking of a dedicated stent in late 2024, a variety of BSG were used. The aim of this study was to evaluate the outcomes of the iCover stent graft in this application. Patients and methods: We retrospectively analysed 22 consecutive patients treated at our institution with FEVAR and BEVAR between 05/2023 and 09/2024. The primary endpoint is a composite of target vessel (TV) technical success and freedom from target vessel instability (TVI) in the early and short-/mid-term phase. Secondary endpoints consisted of early, short- and mid-term clinical outcomes. Results: Ninety-seven iCover stent grafts were used to bridge 90 target vessels: 23 for the coeliac arteries (CA), 23 for the superior mesenteric artery (SMA) and 50 for the renal arteries (RA); one iCover stent could not be implanted. The underlying aortic pathology was juxtarenal and pararenal aneurysm (12/22; 54,5%), penetrating aortic ulcer (PAU) (2/22; 9%), type Ia endoleak following infrarenal EVAR (3/22; 13,6%), chronic type B aortic dissection with aneurysmal degeneration (1/22; 4,5%), Safi type IV (3/22; 13.6%) and Safi type V (1/22; 4.5%) thoraco-abdominal aortic aneurysm (TAAA). The mean aneurysm diameter was 60,5 mm (+/- 10,6 mm). Four (18,2%) patients underwent urgent procedures. The median follow-up was 291,5 days (IQR 63-425,2). 3 patients (13,6%) died from non-aneurysm-related causes. Assisted primary TV technical success was 98,88% (89/90). One non-iCover related loss of TV was excluded from mid-term analysis. The TV patency was 98,88% (89/90) in the early phase and 98,87% (88/89) at mid-term follow-up. Cumulative freedom from TVI was 92,13% (82/89). Conclusions: The iCover is effective and safe to use as a BSG in fenestrated endovascular aortic repair. Our results align with the available literature, but further studies are needed to validate iCover as BGS, especially in BEVAR.