{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:13:42Z","timestamp":1779358422285,"version":"3.51.4"},"reference-count":22,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: To evaluate the feasibility and early outcomes of a curvature-guided strategy that guides dual-branch revascularization during Zone 1 Thoracic Endovascular Aortic Repair (TEVAR) based on whether the aortic pathology is predominantly located on the greater or lesser curvature of the arch. Methods: In this retrospective, descriptive study (February 2023\u2013June 2024), 43 consecutive patients were included under a predefined anatomical protocol. Of these, 3 patients (7.0%) were lost to follow-up and were included in the analysis of baseline characteristics and perioperative outcomes. The remaining 40 patients constituted the per-protocol follow-up cohort. Pathologies predominantly on the aortic arch\u2019s greater curvature (n = 21) were managed with a Castor single-branched stent-graft for the left subclavian artery (LSA) and a left common carotid artery (LCCA) chimney stent. Those on the lesser curvature (n = 22) received a physician-modified endograft (PMEG). The primary outcome was technical success; secondary outcomes included safety, branch patency, and reintervention. Results: The overall technical success rate was 97.7% (100% in the Castor-chimney cohort [21\/21] vs. 95.5% in the PMEG cohort [21\/22]). No perioperative stroke, spinal cord ischemia, or retrograde type A dissection occurred in either cohort. Two type II endoleaks were observed: one intraoperative in the Castor-chimney cohort and one during follow-up in the PMEG cohort. Among the 40 patients (20 per cohort) who completed a median follow-up of 22.5 months, freedom from aortic-related reintervention was 95% (38\/40), with one reintervention occurring in each cohort. Branch patency was 100% (20\/20) in the PMEG cohort, whereas it was 95% (one asymptomatic LSA occlusion) in the Castor-chimney cohort. Conclusions: The implementation of a curvature-guided protocol, which rationally matches endograft techniques to arch anatomy, suggests acceptable early safety and efficacy for complex Zone 1 TEVAR. This anatomy-driven framework offers a potential personalized approach to dual-branch revascularization and warrants prospective validation.<\/jats:p>","DOI":"10.3390\/jcm15103961","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T09:29:58Z","timestamp":1779355798000},"page":"3961","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Outcomes of a Curvature-Guided Strategy for Dual-Branch Revascularization in Zone 1 TEVAR"],"prefix":"10.3390","volume":"15","author":[{"given":"Lei","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China"},{"name":"The Institute of Vascular Diseases, Central South University, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang","family":"Shu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China"},{"name":"The Institute of Vascular Diseases, Central South University, Changsha 410011, China"},{"name":"State Key Laboratory of Cardiovascular Diseases, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China"},{"name":"The Institute of Vascular Diseases, Central South University, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dexiang","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China"},{"name":"The Institute of Vascular Diseases, Central South University, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China"},{"name":"The Institute of Vascular Diseases, Central South University, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.ejvs.2025.12.050","article-title":"European Society for Vascular Surgery (ESVS) 2026 Clinical Practice Guidelines on the Management of Descending Thoracic and Thoraco-Abdominal Aortic Diseases\u2014Editor\u2019s Choice","volume":"71","author":"Wanhainen","year":"2026","journal-title":"Eur. 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