Abstract:Background and Aims Endovascular repair of aortic arch diseases poses a major challenge in vascular surgery due to the need to both effectively exclude the lesion and preserve perfusion of supra-aortic branch vessels. The Castor branched aortic covered stent, with its integrated design and ability to maintain left subclavian artery (LSA) patency, offers potential advantages. When combined with the chimney technique for the left common carotid artery (LCCA), it may provide a minimally invasive and feasible solution for patients with insufficient proximal landing zones. This study aims to evaluate the preliminary feasibility and safety of this combined approach and provide clinical reference for the endovascular management of complex aortic arch pathologies.Methods A retrospective analysis was conducted on 15 patients with aortic arch diseases who underwent treatment with the Castor branched stent-graft combined with LCCA chimney stenting at the Second Xiangya Hospital of Central South University between February 2023 and December 2024. Baseline characteristics, surgical procedures, perioperative complications, and follow-up outcomes were analyzed to assess technical success, complication rates, and branch vessel patency.Results Among the 15 patients (11 males, average age 63.8 years), primary diagnoses included aortic dissection (33.4%), aortic arch aneurysm (53.3%), and penetrating aortic ulcer (13.3%). The technical success rate was 100%, with no perioperative deaths or major complications. During the follow-up period (4-26 months, mean 12.9 months), no adverse events such as stroke, paralysis, endoleak, or stent migration occurred. The patency rate of both the LCCA and LSA remained 100%.Conclusion The Castor branched aortic stent-graft combined with LCCA chimney technique appears to be a technically feasible and safe short-term option for treating aortic arch diseases with insufficient proximal landing zones. It may serve as a promising alternative for complex aortic arch repair; however, large-scale, multicenter studies with long-term follow-up are needed to further validate its efficacy and safety.