Key result
Novel zone 1.5 TEVAR with thoracic branched endoprosthesis demonstrates feasibility in early case series.
Why the study?
Zone 1 thoracic endovascular aortic repairs require a carotid-subclavian bypass and zone 0 repairs carry higher stroke risk, prompting evaluation of a novel zone 1.5 approach when standard repairs are unfeasible.
Does a "zone 1.5" deployment of the TAG thoracic branched endoprosthesis provide favorable outcomes in patients requiring thoracic endovascular aortic repair?
Case Report (n=3)
Does a "zone 1.5" deployment of the TAG thoracic branched endoprosthesis provide favorable outcomes in patients requiring thoracic endovascular aortic repair?
A novel "zone 1.5" TEVAR approach using a branched endoprosthesis and left subclavian-to-left carotid bypass may offer a feasible alternative to zone 0 repair.
May offer a less invasive zone 1 option; leaves open need for prospective trials before practice change.
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.
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Satam et al. (2025) conducted a case report in Thoracic aortic disease requiring endovascular repair (n=3). "Zone 1.5" deployment of the Gore thoracic branched endoprosthesis device was evaluated on Favorable outcomes. A novel 'zone 1.5' approach to thoracic endovascular aortic repair using the Gore thoracic branched endoprosthesis was successfully performed in 3 patients with favorable outcomes.
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