ヘクターマルチブランチ胸部ステントグラフトシステムおよび接続ステントを用いた胸部大動脈弓閉鎖血管内修復の解剖学的妥当性

Endovascular repair of the aortic arch has emerged as an alternative to open surgery, particularly for high-risk and elderly patients. While multibranched endografts have demonstrated technical success, anatomical suitability remains a key limiting factor, especially given the variability of arch anatomy. The aim of the present study is to evaluate the suitability of the Hector multibranch device in a cohort of patients who underwent endovascular treatment for aortic arch's lesions.

A total of 539 patients were treated between 1999 and 2024, with 79 included in a single-center, retrospective, preclinical study. The suitability for device and its connecting stent was defined according to the manufacturer's instructions for use. Extended suitability was also evaluated, including patients excluded for limiting anatomical criteria. Secondary outcomes were suitable and non-suitable patients' comparison, exclusion causes analysis, and anatomical characteristics associated with suitability. A logistic regression model assessed associations between baseline and non-suitability.

A total of 50 patients (63.2%) were suitable for implantation, raising to 54 (68.4%) by using other available bridging stents. Approximately half of the eligible patients could have been treated using 14 configurations for the analyzed device. The left common carotid artery bridging stent was appropriate for all suitable patients, while the appropriateness rate for the left subclavian artery stent was 92.6%. The odds of non-feasibility increased with proximal landing zone shortening (OR=1.05, p=0.015), whereas each additional millimeter in BCT length increased the odds of suitability by 6% (OR=1.06, p=0.046).

The Hector Stent Graft system coupled with commercially available bridging stents for supra-aortic trunks proved to be feasible for more than two-thirds of patients previously subjected to an endovascular treatment for aortic arch pathologies. The left common carotid artery bridging stent was suitable for all patients, while the one for the left subclavian artery was adequate for 9 out of 10 cases.Clinical ImpactThe Hector™ Stent Graft system shows high anatomical feasibility for endovascular aortic arch repair, with broad applicability using limited configurations. Its design may help minimize supra-aortic-trunks manipulation and facilitate safer, more streamlined procedures to treat the aortic arch pathologies in a complete endovascular fashion.