A novel approach to thoracic endovascular aortic repair using “zone 1.5” deployment of the Gore thoracic branched endoprosthesis device

The TAG thoracic branched endoprosthesis is Food and Drug Administration approved for zone 2 repair with a branch to the left subclavian artery. Zone 1 repairs require a carotid-subclavian bypass, and zone 0 may necessitate full arch debranching with higher stroke risk. We propose a "zone 1.5" approach: coverage distal to the innominate artery, subclavian branch via the device, and left subclavian-to-left carotid bypass to perfuse the carotid. Among 75 thoracic branched endoprosthesis patients in our registry, three underwent this "zone 1.5" repair with favorable outcomes. This strategy may offer a safer alternative to zone 0 when standard zone 2 or 1 repairs are not feasible.