PT - JOURNAL ARTICLE AU - Dhanekula, Arjune S AU - Sweet, Matthew P AU - Desai, Nimesh AU - Burke, Christopher R TI - Aortic arch stenting: current strategies, new technologies and future directions AID - 10.1136/heartjnl-2020-317732 DP - 2021 Aug 01 TA - Heart PG - 1199--1205 VI - 107 IP - 15 4099 - http://heart.bmj.com/content/107/15/1199.short 4100 - http://heart.bmj.com/content/107/15/1199.full SO - Heart2021 Aug 01; 107 AB - Operating on the aortic arch is a formidable challenge. Open operations remain the gold standard, but despite improvement in technique and outcomes, they are still associated with significant morbidity and mortality. The last 20 years have seen a remarkable reduction in the operative morbidity associated with treatment of the descending thoracic aorta using thoracic endovascular aneurysm repair (TEVAR). To improve outcomes following arch repair, new TEVAR devices, including both single-branched and multibranched designs, have come to clinical trial. This review discusses the modern state of open and hybrid repairs while introducing the reader to technology for endovascular therapy of the aortic arch. We describe important anatomical and operative considerations for the devices. Given these nuances, we believe the future of the aortic arch to be patient-individualised hybrid repairs, involving both open and endovascular options with a multidisciplinary ‘thoracic aorta team’ at the helm.