Early Multicenter Experience with the Nexus Duo™ Aortic Arch Stent Graft System in the Treatment of Aneurysmatic Aortic Arch Diseases

BACKGROUND: The Nexus Duo endograft is a novel device designed for endovascular repair of aneurysmal disease of the aortic arch (EAAR). It features a dedicated indwelling branch for the brachiocephalic trunk and a customized retrograde branch for either the left common carotid artery (LCCA) or left subclavian artery (LSA). This study evaluates the early clinical outcomes of the Nexus Duo endograft in EAAR. METHODS: This multicenter, observational, physician-sponsored registry retrospectively analyzed prospectively collected data from nine European centers. All consecutive patients who underwent EAAR with the Nexus Duo endograft between January 2023 and April 2025 were included in the study. The primary end point was 30-day mortality. Secondary end points included technical success, overall reinterventions, major adverse events (MAEs), and the incidence of endoleaks at 30 days. RESULTS: Thirty patients (53% female) were treated. Indications for EAAR included nondissecting aneurysm (n = 7, 23.3%), post type-B-dissection aneurysm (n = 7, 23.3%), post type-A-dissection aneurysm (n = 14, 46.7%), false aneurysm (n = 1, 3.3%), and penetrating ulcer (n = 1, 3.3%). The LSA was the target vessel in 17 patients (56.7%). Seventeen patients underwent simultaneous LCCA-LSA bypass (58.6% using polytetrafluoroethylene grafts). Technical success was 100%. At 30 days, the mortality rate was 3.3% (n = 1), the reintervention rate was 16.7%, and the MAE rate was 6.7%. No disabling strokes were observed. One transient ischemic attack occurred and one type Ia endoleak (3.3%) were observed at 30 days. CONCLUSIONS: In this real-world, multicentre study, the Nexus Duo endograft demonstrated a favorable early safety profile, with high technical success, no disabling strokes, and encouraging 30-day outcomes.