Anomalous left vertebral artery in patients undergoing total arch replacement: Results from a prospective trial
Year: 2026
Type: article
Abstract: Objective: Anomalous left vertebral artery (ALVA) originating from the aorta presents a challenge when performing total arch replacement. This has been addressed with in situ stent grafting using the hybrid branched stented anastomosis frozen elephant repair (B-SAFER) technique and studied as part of a prospective, physician-sponsored investigational device exemption trial. We describe management and outcomes in patients with ALVA undergoing B-SAFER. Methods: A total of 15 of 420 (4%) patients who underwent B-SAFER from May 2021 to February 2025 had ALVA. Average age was 63 ± 10 years, and 12 (80%) were male. Indications were acute dissection 7 (47%), chronic dissection 4 (27%), and degenerative aneurysm 4 (27%). No patients had a previous stroke, 3 (20%) had a history of transient ischemic attack (TIA), 4 (27%) had carotid artery disease, and 4 (27%) had a history of atrial fibrillation. Average circulatory arrest time was 55 ± 28 minutes. Average follow-up time was 525 ± 374 days. Results: ALVA was stent grafted in 13 (87%) patients and ligated/covered in 2 (13%) patients. Average ALVA diameter was 5.4 ± 1.7 mm in stented and 3.3 ± 0.4 mm in nonstented patients. One patient died from cardiac arrest on postoperative day 26 after hospital discharge. There were no acute strokes, TIAs, or spinal cord ischemia events. In late follow-up, 1 TIA occurred, and there were no strokes. Paraparesis occurred in 1 patient after thoracic endovascular aortic repair 5 months postoperatively. All ALVA stents were patent on follow-up computed tomography angiography. Mean modified Rankin scale score was 1.4 ± 1.2 after discharge and 0.9 ± 1.3 on most recent follow-up. Conclusions: Stent grafting of a prominent anomalous left vertebral artery during total arch replacement using the B-SAFER technique appears feasible and safe in selected patients and is durable at intermediate follow-up.
Source: JTCVS Techniques
Authors: Rohun Bhagat, Abigail Snyder, Patrick Vargo, M. Shazam Hussain, Vidyasagar Kalahasti, Donna Kimmaliardjuk, Marijan Koprivanac, Yuki Kuramochi, Xiaying Lou, Sean Lyden, Lars G. Svensson, Shinya Unai, Eric E. Roselli, Eric E. Roselli, Marc Gillinov, Patrick Vargo, Faisal Bakaeen, Edward Soltesz, Michael Zhen-Yu Tong, Shinya Unai, Haytham Elgharably, Francis Caputo, Lee Kirksey, Jon Quatromoni, Marijan Koprivanac, Ali Khalifeh, Ravi Ambani, Anthony Zaki, Tarek Malas, Xiaoying Lou, Donna Kimmaliardjuk, Courtney Hanak, Juan Umana, Per Wierup, Benjamin Kramer, James Witten, Bradley Rosinski, Shawn Shah, William Frankel, Davut Cekmecelioglu, Ben Yang, Haley Jenkins, Rohun Bhaga, Emily Vianna, Andrew Tang, Anibel Ibanez, Munir Ahmad, Nadia Bakir, Sebastian Cirio, Jorge Balzan, Holliann Umana, Kenton Stephens, Ahmed Al Khamis, Abdulaziz Alhossan, Sashelin Naidoo, Gregory Jones, Muhammad Zubair, Ciro Amodio, Matthew Thompson, Nika Samadzadeh Tabrizi, Feredun Azari, Hatem Sarhan, Albert Pai, Han Li, Baraa Ibrahim, Hector Contreras Garza, Ananthanarayanan Chandrasekaran, Nicholas Oh, Daniel Ragheb, Srikrishna Modugula, Jean-Luc Maigrot, Hyunchang Kwak, Andrew Jones
Institution: Cleveland Clinic
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,553
OpenAlex ID: W7128025879