A D V A N C E D M A T E R I A L S & P R O C E S S E S | A P R I L 2 0 2 2 5 4 THORACICSTENT GRAFT DELIVERY SYSTEM ADAPTS TOPATIENT’S ANATOMY A new TEVAR delivery system allows staged, predictable endograft deployment and in situ angulation control, while avoiding windsocking and bird-beaking. The introduction of thoracic endovascular aortic repair (TEVAR) has completely changed clinicians’ attitudes and approaches in the treatment of thoracic aortic pathologies[1]. Since the advent of TEVAR, the use of endovascular repair to treat increasingly complicated disease states in challenging aortic anatomies has grown. Thoracic endografting provides a therapeutic option to a rising number of patients who are not good candidates for open repair or who prefer a minimally invasive approach[2]. Over the years, much progress has been made to improve TEVAR in terms of the design of both the stent graft and the delivery system. However, despite recent advancements, TEVAR is not free from complications, and challenges with bird-beaking and windsocking continue to be a problem, especially in the aortic arch. Failure to conform to arch anatomy may increase the risk of type I endoleak, which, if left untreated, can result in aortic rupture and possibly death. Windsocking due to high blood flow velocity and pressure in the aortic arch can lead to difficulties with precise deployment. This is especially true with deployment mechanisms where the proximal end opens while the distal end remains constrained. Predictability of deployment is also important at the level of the distal landing zone to avoid covering of the visceral arteries. To overcome these challenges, a conformable thoracic stent graft with delivery system from GORE introduces novel features that help to enhance deployment accuracy and stent graft apposition and to fully take advantage of the stent graft’s conformability. TECHNICAL CONSIDERATIONS The GORE® TAG® Conformable Thoracic Stent Graft with ACTIVE CONTROL System combines the company’s conformable GORE® TAG® Device with a novel nested handle delivery system. The stent graft therefore has the same conformable stent graft design with sutureless graft attachment, oversizing windows that enable optimized radial fit, and indications and anatomic requirements. The principle of operation is also maintained, with a fiber deployment mechanism that is actuated to release the self-expanding stent graft from a constraining sleeve. The delivery system features a nested handle that separates stent graft expansion into two deployment steps, each requiring actuation of a separate handle component (Fig. 1). Deployment consists of four required steps and two optional angulation steps. Removal of the primary deployment handle TECHNICAL SPOTLIGHT 8 Fig. 1 — The GORE TAG Conformable Thoracic Stent Graft with Active Control System and associated accessory devices. The stent graft design remains the same as the previous-generation Conformable GORE TAG Device. Fig. 2 — The nested handle of the TEVAR system enables stepwise deployment and optional angulation of the device. This figure shows the device deployed to its intermediate diameter after removal.
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