A novel approach to thoracic endovascular aortic repair using "zone 1.5" deployment of the Gore thoracic branched...

The TAG thoracic branched endoprosthesis is Food and Drug Administration approved for zone 2 repair with a branch to the left subclavian artery. Zone 1 repairs require a carotid-subclavian bypass, and zone 0 may necessitate full arch debranching with higher stroke risk. We propose a "zone 1.5" approach: coverage distal to the innominate artery, subclavian branch via the device, and left subclavian-to-left carotid bypass to perfuse the carotid. Among 75 thoracic branched endoprosthesis patients in our registry, three underwent this "zone 1.5" repair with favorable outcomes. This strategy may offer a safer alternative to zone 0 when standard zone 2 or 1 repairs are not feasible.