Suitability of Single-Branched Thoracic Endografts for the Treatment of Acute Type B Aortic Dissection-An Anatomical Feasibility and Comparative Study
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Updated: Jan 29, 2026
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Published on: March 28, 2025
Julius Lang1,2, Lorenz Meuli1, Philip Dueppers1,3
1Department of Vascular Surgery, University Hospital Zurich, Rämistr. 100, 8091 Zurich, Switzerland.
Insights
This study assessed thoracic stent grafts for acute type B aortic dissection. While both Castor and TBE show promise, limited configurations necessitate adjunctive procedures, impacting treatment efficiency and cost.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Engineering
Background:
- Acute type B aortic dissection (TBAD) requires effective proximal landing zones for endovascular repair.
- Thoracic stent grafts are crucial for treating TBAD, with proximal landing in aortic arch zone 2 being a key challenge.
- The anatomical suitability of different stent graft configurations for TBAD treatment remains an area of active investigation.
Purpose of the Study:
- To evaluate the anatomical suitability of Castor and Thoracic Branch Endoprosthesis (TBE) stent grafts for proximal landing in aortic arch zone 2 in TBAD patients.
- To determine the minimal number of configurations required for off-the-shelf availability of these devices.
- To assess the potential for adapting custom-made devices (CMD) into off-the-shelf options.
Main Methods:
- Retrospective analysis of computed tomographic angiographies from 100 TBAD patients treated between 2004 and 2023.
- Morphometric measurements using centerline analysis software to assess anatomical suitability based on manufacturer criteria.
- Evaluation of off-the-shelf suitability and the impact of adjunctive procedures for both Castor and TBE stent grafts.
Main Results:
- 82% of TBAD cases were suitable for the Castor CMD with 74 configurations; 13 configurations could cover all morphologies with adjunctive procedures.
- 34% of Castor cases were treatable off-the-shelf, while 48% required additional interventions.
- Off-the-shelf suitability for TBE was 22%, increasing to 78% with adjunctive procedures using six main bodies and five branches.
Conclusions:
- Both Castor and TBE stent grafts demonstrate potential for proximal thoracic endovascular aortic repair in TBAD.
- Limited stent graft configurations increase the need for adjunctive procedures, potentially affecting treatment efficiency and cost.
- Optimizing stent graft configurations is crucial for improving off-the-shelf applicability and streamlining TBAD management.
Abstract:
Objectives: This study evaluated the anatomical suitability of two single-branched thoracic stent grafts-the Castor (Endovastec, China) and the Thoracic Branch Endoprosthesis (TBE, Gore, USA)-for proximal landing in aortic arch zone 2, including the left subclavian artery (LSA), in patients with acute type B aortic dissection (TBAD). While the TBE is currently available as an off-the-shelf device (26 main bodies, 8 branch configurations), the study also aimed to define the minimal number of configurations needed to treat most patients. The same approach was applied to the Castor stent graft, currently only available as a custom-made device (CMD), to assess its potential for off-the-shelf adaptation. Methods: A retrospective analysis was performed on computed tomographic angiographies of TBAD patients treated between 2004 and 2023. Exclusion criteria included type A or non-A-non-B dissections, isolated abdominal dissections, intramural hematomas, and lack of consent. Morphometric measurements were conducted using centerline analysis software. Suitability was defined per manufacturers' criteria and reported with 95% confidence intervals. Results: Among 100 TBAD cases, 82% (95% CI: 73.3-88.3%) were suitable for the Castor CMD with 74 configurations. Main causes of exclusion were short landing zones and atypical arch anatomies. With adjunctive procedures, 13 Castor configurations covered all morphologies; 34% could be treated off-the-shelf, and 48% required additional interventions. For the TBE, off-the-shelf suitability was 22%, increasing to 78% with adjunctive procedures (six main bodies, five branches). Conclusions: Both stent grafts are promising for proximal extension in TBAD. Reduced configuration availability necessitates more adjunctive procedures, impacting efficiency and cost.
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