Proximal Sealing in Zone 1-2 Using the Castor Stent-Graft: Early Results from an Italian Multicenter Registry

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Thoracic endovascular aortic repair (TEVAR) is a minimally invasive treatment for thoracic aortic pathologies.
• The Castor single-branched stent graft offers a potential solution for complex TEVAR cases, particularly those requiring proximal landing zones 1 or 2.
• Real-world data on the outcomes of the Castor stent graft are limited.

Purpose of the Study:

• To evaluate the early and mid-term outcomes of TEVAR using the Castor single-branched stent graft.
• To assess technical success, intraoperative complications, and deployment accuracy.
• To determine the rates of aortic-related mortality, neurological complications, reinterventions, and endoleaks.

Main Methods:

• Retrospective, nonrandomized, multicenter study of 51 patients treated with the Castor stent graft between January 2019 and April 2025.
• Patients had thoracic aortic pathologies requiring TEVAR in proximal landing zones 1 or 2.
• Primary endpoints: technical success, intraoperative major adverse events (MAEs), deployment accuracy. Secondary endpoints: mortality, neurological complications, reinterventions, endoleaks.

Main Results:

• High technical success rate (94.1%) with no intraoperative deaths or MAEs.
• Two cases (3.9%) of minor embolic stroke observed in zone 1 procedures.
• Median follow-up of 22.3 months showed no additional endoleaks or neurological events, with 100% branch patency.

Conclusions:

• The Castor single-branched stent graft is a feasible option for TEVAR in zone 2.
• The device demonstrates high technical success and low rates of neurological complications.
• Careful case selection and procedural planning are crucial for optimal outcomes.