In Vitro Comparison of Retrograde In Situ Fenestration Using a Re-entry Catheter vs Electrified Guidewire in Thoracic Endografts

The EW-ISF showed high technical feasibility across both analyzed grafts, producing consistent, easily reproducible, and dimensionally stable fenestrations. In contrast, REC-ISF demonstrated material-dependent technical limitations under the constraints of this model. These findings support the use of EW-ISF as an off-the-shelf ISF option in emergency settings when other fenestration tools (ie, excimer laser) are unavailable, even if a head-to-head comparison is warranted.Clinical ImpactThis paper presents a proof-of-concept evaluation of two newly described off-the-shelf techniques for in situ fenestration (ISF) in thoracic stent-grafts: electrified guidewire ISF (EW-ISF) and re-entry device ISF (RED-ISF). The findings demonstrate a clear technical advantage of EW-ISF, which achieved higher puncture success, more reproducible fenestration geometry, and greater dimensional stability compared with RED-ISF. As such, EW-ISF emerges as a more reliable off-the-shelf option when dedicated fenestration tools-such as excimer lasers-are unavailable. These results may broaden endovascular treatment possibilities in time-critical or anatomically challenging scenarios, ultimately enhancing procedural success and branch preservation during emergency thoracic aortic interventions.