ArticleJTCVS structural and endovascular2025
Next frontier in endovascular aortic therapy: An anatomic analysis of feasibility of endovascular treatment of ascending thoracic aortic aneurysms.
Article in JTCVS structural and endovascular, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- The NAVIGATE Registry: Early Endovascular Repair of the Ascending Aorta With the Nexus Ascending Module.Interdisciplinary cardiovascular and thoracic surgery · 2026Article
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Authors and funding
9 authors.
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Abstract
Objectives: Ascending thoracic aortic aneurysms (ATAAs) are the next frontier for endovascular aortic repair. This study evaluates anatomic characteristics of ATAAs to inform future design of ascending aortic endografting. Methods: Treatment In Thoracic Aortic aNeurysm: Surgery versus Surveillance is a multicenter trial randomizing patients with ATAA of 5.0 to 5.4 cm to surgery versus surveillance with a parallel real-world Registry. Computed tomography scans from the Treatment In Thoracic Aortic aNeurysm: Surgery versus Surveillance Registry were assessed by a core imaging lab to determine feasibility of endografting on the basis of Information for Use for the Gore Ascending Aortic graft, the only investigational device currently under trials for the ascending aorta. Results: In total, 150 consecutive patients with ATAA ≥5 cm and high-quality computed tomography scans were included. A diameter between 27 and 48 mm existed in 46% (69/150) of patients at the proximal landing zone and 94% (141/150) at the distal landing zone. Arch branching was normal in 68% (102/150), bovine in 21% (38/150), and other in 6.7% (10/150). Mean greater curvature length was 13.2 ± 1.45 cm versus mean lesser curvature of 6.60 ± 0.81 cm. Discrepancy of >5 mm between proximal and distal landing zone diameters existed in 51% (76/150). Conclusions: For ATAAs of 5.0 to 5.4 cm, 3 important challenges to endografting include approximately 50% of patients having a proximal landing zone diameter >48 mm, a 2-fold discrepancy in greater versus lesser aortic curvature length, and >50% of patients with >5-mm mismatch between proximal and distal landing zones. Future stent designs will need to address these important anatomic features unique to the ascending aorta.
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