title: Scalloped thoracic stent-graft for treatment of aortic arch aneurysms with unfavourable landing zones.
abstract: Endovascular treatments are limited in cases of thoracic aortic aneurysms extending up or proximal to the origin of the left subclavian artery (LSCA). In such cases, the LSCA is usually either occluded or revascularised. We report our first experience of four patients who underwent thoracic aneursym treatment with new custom-made grafts with a scallop in situ for the LSCA. The graft is tailor made per case, and a re-enforced scallop is positioned proximally allowing for the stent to be deployed beyond the origin of the LSCA; the origin of the LSCA remains patent, thus negating the need for revascularisation of the head and neck vessels on the left. The stent contains markers for identifying the scallop and are located along the midline to ensure correct alignment. All of the patients who underwent this procedure had technical success with flow through the LSCA both immediately after stent deployment and on follow-up imaging. This new stent has further expanded endovascular treatment options for patients with thoracic aneurysms extending up to and beyond the LSCA, which can play a part in improving outcome and decreasing mortality rates because surgery for revascularization will not be needed.
authors.affiliation: Department of Interventional Radiology, St. Mary's Hospital, Imperial College, London, UK. Elika.kashef@imperial.nhs.uk
authors.forename: Elika
authors.initials: E
authors.lastname: Kashef
authors.forename: Zaid
authors.initials: Z
authors.lastname: Aldin
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jenkins
authors.forename: Richard
authors.initials: R
authors.lastname: Gibbs
authors.forename: Colin D
authors.initials: CD
authors.lastname: Bicknell
authors.forename: Nicholas J W
authors.initials: NJ
authors.lastname: Cheshire
authors.forename: Mohamad S
authors.initials: MS
authors.lastname: Hamady
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D017130:Angioplasty / Q000379:methods*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000628:therapy*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D000497:Alloys; C013616:nitinol