Clinical outcomes of total endovascular aortic arch repair by in situ microneedle fenestration using the triple (stiff)-sheathed gutter technique

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic arch pathologies (aortic arch aneurysm and type non-A-non-B aortic dissection) (n=36). Intervention: Total endovascular aortic arch repair (TEAAR) via in situ micro-needle fenestration (ISMNF) using the triple (stiff)-sheathed gutter technique. Primary outcome: All-cause mortality during follow-up (95% CI 1.8-22.5).

Peng Ye; Hongfei Miao; Zeng Qingle; Wenya Liu; Mingyuan Ma; Yong Chen

doi:10.1186/s42155-026-00788-3

October 29, 2026CVIR EndovascularOpen Access

Clinical outcomes of total endovascular aortic arch repair by in situ microneedle fenestration using the triple (stiff)-sheathed gutter technique

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Key result

Endovascular arch repair via in situ micro-needle fenestration yields ~94% technical success with low mortality.

95% CI 1.8-22.5
n=36

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Why the study?

The clinical outcomes of total endovascular aortic arch repair via in situ micro-needle fenestration using the triple (stiff)-sheathed gutter technique required investigation.

Key Points

To evaluate the feasibility, safety, and midterm clinical outcomes of total endovascular aortic arch repair via in situ microneedle fenestration using the triple (stiff)-sheathed gutter technique.
Retrospective study of 36 consecutive patients undergoing total endovascular aortic arch repair between August 2022 and April 2025.
Three 6-Fr, 90-cm sheaths were retained with dilators and super-stiff guidewires in the ascending aorta during main stent-graft deployment to preserve supra-aortic perfusion prior to microneedle fenestration.
Patients were followed for a median duration of 19 months (range, 1–32 months) with Kaplan-Meier estimates of survival and reintervention.
Technical success was achieved in 94.4% of patients (34/36; 95% CI, 81.3–99.3%), with successful cervical branch reconstruction in 100% of cases.
The 30-day mortality was 2.8% (1/36; 95% CI, 0.1–14.9%), overall stroke occurred in 8.3% (3/36; 95% CI, 1.8–22.5%), and all-cause mortality was 11.1% (4/36) with zero aorta-related deaths.
Kaplan-Meier estimates showed 1- and 2-year survival rates of 97.3% ± 2.7% and 85.8% ± 8.1%, respectively, with freedom from reintervention rates of 87.5% ± 5.9% and 83.2% ± 7.0%.

Study Design

Type

Cohort (n=36)

Structured PICO

P

Population

36 consecutive adults (mean age 64.6 years, 16.7% female) with aortic arch aneurysm (>55 mm or >5 mm/year growth) or non-A-non-B aortic dissection involving three supra-arch branches, followed for a median of 19 months.

I

Intervention

Total endovascular aortic arch repair (TEAAR) in zone 0 via in situ micro-needle fenestration (ISMNF) using a 21-G pre-curved trocar needle to revascularize all three cervical branches (innominate artery, left common carotid artery, and left subclavian artery), combined with the triple (stiff)-sheathed gutter technique (three 6-Fr, 90-cm sheaths with dilators and Lunderquist super-stiff guidewires placed into the ascending aorta during stent-graft deployment to maintain cerebral perfusion), followed by dual antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg daily) for 6 months and lifelong aspirin thereafter.

O

Outcome

Overall mortality, aorta-related mortality, and major adverse events (puncture site bleeding, stroke, spinal cord ischemia, retrograde type A aortic dissection [RTAD], and pneumothorax) at 30 days and during follow-up (median 19 months, range 1-32 months).hard clinical

Limitations

Retrospective single-arm study design
Extensive manipulation with needles, guidewires, and sheaths in the supra-aortic branches and aortic arch carries risks of plaque disruption and embolic stroke, especially in shaggy aortas
Placing multiple long sheaths and super-stiff guidewires in the ascending aorta carries a potential risk of injuring the ascending aorta and causing new-onset dissection
In patients with type III aortic arch, larger angles between the branch vessels and the aorta may increase the risk of puncture failure
Retrospective study design
Extensive manipulation with needles, guidewires, and sheaths in the supra-aortic branches and the aortic arch is associated with risks of plaque disruption and embolic stroke, especially in patients with shaggy aortas
In patients with type III aortic arch, the larger angles between the branch vessels and the aorta may increase the risk of puncture failure

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Implication

Total endovascular aortic arch repair using in situ micro-needle fenestration with a triple-sheathed gutter technique maintains intraoperative cerebral perfusion and achieves a 94.4% technical success rate with acceptable midterm survival (85.8% at 2 years) and a stroke rate (8.3%) comparable to open arch replacement.

Abstract

PURPOSE: To investigate the outcomes of total endovascular aortic arch repair (TEAAR) via in situ micro-needle fenestration (ISMNF) with the triple (stiff)-sheathed gutter technique. MATERIALS AND METHODS: In this retrospective study, the data of consecutive patients who underwent TEAAR via ISMNF with triple (stiff)-sheathed gutter technique between August 2022 and April 2025 were analyzed. Three 6-Fr, 90-cm sheaths were placed into ascending aorta without removing the dilator and super-stiff guidewires during main stent-graft deployment. This configuration creates a gutter between the stent-graft and aortic wall to maintain perfusion to supra-aortic branches. Operative details, technical success, 30-day and midterm outcomes, and adverse events were recorded. Kaplan-Meier analysis was used to estimate freedom from all-cause death and reintervention. RESULTS: Overall, 36 patients were included. The technical success rate was 94.4% (34/36). Endovascular reconstruction of cervical branches was successfully performed in all cases. The 30-day mortality was 2.8%. The median follow-up period was 19 months (range, 1-32 months). The all-cause death rate was 11.1% (4/36), with no cases of any aorta-related death. The prevalence of endoleaks during follow-up was 13.9% (5/36). The overall stroke rate was 8.3% (3/36). The 1- and 2-year survival rates were 97.3% ± 2.7% and 85.8% ± 8.1%, respectively. The cumulative rate of freedom from reintervention at 1 and 2 years was 87.5% ± 5.9% and 83.2% ± 7.0%, respectively. CONCLUSION: TEAAR via ISMNF with the triple (stiff)-sheathed gutter technique was performed with a 94% technical success rate and stroke risk similar to open surgery.

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Cite This Study

Ye et al. (2026) conducted a cohort in Aortic arch pathologies (aortic arch aneurysm and type non-A-non-B aortic dissection) (n=36). Total endovascular aortic arch repair (TEAAR) via in situ micro-needle fenestration (ISMNF) using the triple (stiff)-sheathed gutter technique was evaluated on All-cause mortality during follow-up (95% CI 1.8-22.5). Total endovascular aortic arch repair via in situ micro-needle fenestration achieved a 94.4% technical success rate, 2.8% 30-day mortality, 8.3% stroke rate, and 11.1% midterm all-cause mortality.

synapsesocial.com/papers/6aee6b6871a75948062208be https://doi.org/10.1186/s42155-026-00788-3

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Clinical outcomes of total endovascular aortic arch repair by in situ microneedle fenestration using the triple (stiff)-sheathed gutter technique

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clinical outcomes of total endovascular aortic arch repair by in situ microneedle fenestration using the triple (stiff)-sheathed gutter technique

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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