Building an Endovascular Skeleton: Prophylactic Stenting in a Hybrid Approach to a Thymic Carcinoma with Supra-aortic Trunk Encasement

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Locally advanced thymic squamous cell carcinoma with vascular involvement (n=1). Intervention: Hybrid approach with prophylactic endovascular stenting and open radical tumor resection. Primary outcome: Complete oncological resection (R0) and vessel patency.

Marco Campolmi; Alessandro Gonfiotti; Sara Speziali

doi:10.1016/j.ejvsvf.2026.08.002

January 1, 2026EJVES Vascular ForumOpen Access

Building an Endovascular Skeleton: Prophylactic Stenting in a Hybrid Approach to a Thymic Carcinoma with Supra-aortic Trunk Encasement

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Key result

Prophylactic supra-aortic stenting enables complete R0 resection in locally advanced thymic carcinoma.

n=1

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Why the study?

Locally advanced thymic carcinomas with supra-aortic vessel involvement are often deemed unresectable due to surgical challenges and neoadjuvant radiotherapy-induced fibrosis, with limited literature on hybrid endovascular and open surgical approaches.

Key Points

To evaluate the feasibility and safety of a hybrid surgical approach incorporating prophylactic endovascular stenting for the radical resection of a locally advanced thymic carcinoma encasing supra-aortic vessels.
A 45-year-old man with stage III thymic squamous cell carcinoma received neoadjuvant chemoradiotherapy and was selected for a staged hybrid surgical strategy (N=1).
Stage 1 involved prophylactic deployment of three balloon-expandable stent grafts in the supra-aortic vessels under local anesthesia via right percutaneous axillary artery access.
Stage 2 comprised radical tumor resection via median sternotomy and cervical approach, left subclavian-to-carotid prosthetic bypass, and antithrombotic bridging with cangrelor, aspirin, and low-molecular-weight heparin.
Complete oncological radicality (R0 resection) was achieved without arterial breach or the need for emergency vascular clamping.
The patient recovered without major procedural complications and was discharged on post-operative day 19.
At the three-month follow-up, the patient was asymptomatic, with imaging confirming the patency of both the stent grafts and the prosthetic bypass.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 45-year-old man with a locally advanced thymic squamous cell carcinoma and supra-aortic trunk encasement followed for 3 months postoperatively.

I

Intervention

Two-stage hybrid surgical approach: 1) Prophylactic endovascular stenting of the left common carotid, left subclavian, and innominate arteries via percutaneous right axillary access under local anesthesia, followed by antithrombotic bridging with intravenous cangrelor, oral aspirin, and low molecular weight heparin. 2) Three days later, radical en bloc tumor resection with a left subclavian to left common carotid artery prosthetic bypass.

O

Outcome

Clinical recovery, bypass and stent patency, and resolution of symptoms at 3-month follow-up.

Limitations

Single case report design
Long-term follow-up remains necessary to evaluate oncological control and durability of vascular reconstructions
Long term follow up remains necessary to evaluate oncological control and durability of vascular reconstructions.

Implication

Prophylactic endovascular stenting of partially encased supra-aortic vessels provides a rigid protective skeleton that enables safe, aggressive oncological resection in highly complex, irradiated mediastinal tumors previously deemed unresectable.

Abstract

Introduction: Locally advanced thymic carcinomas with supra-aortic vessel involvement pose significant surgical challenges and are historically often deemed unresectable. Neoadjuvant radiotherapy further complicates surgical resection by inducing severe tissue fibrosis. The integration of endovascular techniques with open surgery can expand the boundaries of oncological radicality; however, literature on such hybrid approaches for mediastinal tumours remains limited. Report: with the tumour, and vascular continuity was restored using a left subclavian to carotid prosthetic bypass. The patient recovered well and was discharged on post-operative day 19. At the three month follow up, he was asymptomatic, with imaging confirming the patency of both the stents and the bypass. Conclusion: Prophylactic endovascular stenting of partially encased supra-aortic vessels offers crucial structural and haemostatic protection, facilitating safe and aggressive oncological resection in hostile, irradiated fields. This tailored, hybrid multidisciplinary approach provides a viable pathway to achieving true oncological radicality (R0) in highly complex mediastinal tumours previously considered inoperable.

Discussion

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Cite This Study

Campolmi et al. (2026) conducted a case report in Locally advanced thymic squamous cell carcinoma with vascular involvement (n=1). Hybrid approach with prophylactic endovascular stenting and open radical tumor resection was evaluated on Complete oncological resection (R0) and vessel patency. Prophylactic endovascular stenting of partially encased supra-aortic vessels facilitated a successful complete (R0) oncological resection in a patient with locally advanced thymic carcinoma.

synapsesocial.com/papers/6ad0fcb515427f6a8404029f https://doi.org/10.1016/j.ejvsvf.2026.08.002

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Building an Endovascular Skeleton: Prophylactic Stenting in a Hybrid Approach to a Thymic Carcinoma with Supra-aortic Trunk Encasement

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Building an Endovascular Skeleton: Prophylactic Stenting in a Hybrid Approach to a Thymic Carcinoma with Supra-aortic Trunk Encasement

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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