Off-the-shelf multibranched stents show promise for aneurysm patients

EARLY results are promising for use of the first off-the-shelf multibranched stent in aneurysm patients. Five months after receiving this treatment, a small group of patients has survived and remained free of rupture. Although custom-made devices have been available for more than a decade, these readily available “t-Branch” stents offer greater resources for treatment of thoracoabdominal aortic aneurysm.

The current issue of the Journal of Endovascular Therapy presents a retrospective review* of 15 patients who were implanted with the Zenith t-Branch stent. The stent has four downward facing branches and can be combined with a number of individual components, such as tapered thoracic endografts and universal distal bodies. Previous study has shown that a standardized endograft would be suitable for nearly 88 percent of patients with thoracoabdominal aortic aneurysms.

The aorta delivers blood from the heart to the rest of the body. A thoracoabdominal aortic aneurysm—a weakness in the wall of the aorta—can rupture, causing uncontrolled bleeding that can be fatal if not treated immediately. A complex surgical procedure, open repair of thoracoabdominal aortic aneurysms, has been associated with high mortality and morbidity.

Since their introduction 13 years ago, custom-made multibranched endografts have been proven to reduce mortality and morbidity among aneurysm patients. However, these customized stents require manufacturing times of at least 8 weeks, making them unavailable when a patient needs urgent treatment. One year ago, the first commercially made off-the-shelf thoracoabdominal t-Branch became available in Europe.

Among the 15 patients treated with this t-Branch stent between November 2012 and May 2013, none have died, and no branch occlusion or type I or III endoleaks have occurred. Type II endoleaks were observed in five patients, one patient suffered paraplegia, and four patients experienced transient paraparesis that was resolved. These short-term results indicate that use of an off-the-shelf t-Branch endograft is practicable and safe.

An accompanying commentary suggests some improvements or alternate versions of a standardized t-Branch stent that may help resolve certain issues. The author notes that the design is still evolving, and time will tell which stent approach best meets treatment needs.

* Michel J. Bosiers, Theodosios Bisdas, Konstantinos P. Donas, Giovanni Torsello, and Martin Austermann (2013) , “Early Experience With the First Commercially Available Off-the-Shelf Multibranched Endograft (t-Branch) in the Treatment of Thoracoabdominal Aortic Aneurysms”. Journal of Endovascular Therapy: December 2013, Vol. 20, No. 6, pp. 719-725.