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Stroke Following Thoracic Endovascular Aortic Repair: Determinants, Short and Long Term Impact.
- Source :
-
Seminars in thoracic and cardiovascular surgery [Semin Thorac Cardiovasc Surg] 2023 Spring; Vol. 35 (1), pp. 19-30. Date of Electronic Publication: 2022 Jan 26. - Publication Year :
- 2023
-
Abstract
- We performed a contemporary assessment of clinical and radiographic factors of stroke after thoracic endovascular aortic repair (TEVAR). Patients undergoing TEVAR from 2006 to 2017 were identified. We assessed clinical and radiographic data, including preoperative head and neck computed tomography, Doppler ultrasonography, and intraoperative angiography. Our primary outcome was stroke after TEVAR. Four hundred seventy-nine patients underwent TEVAR, mean age 68.1 ± 19.5 years, 52.6% male. Indications for TEVAR included aneurysms (n = 238, 49.7%) or dissections (n = 152, 31.7%). Ishimaru landing zones were Zone 2 (n = 225, 47.0%), Zone 3 (n = 151, 31.5%), or Zone 4 (n = 103, 21.5%). Stroke occurred in 3.8% (n = 18) of patients, with 1.9% (8) major events (modified Rankin Scale >3). Pathophysiology was predominantly embolic (n = 14), and occurred in posterior (n = 6), anterior (n = 6), or combined circulation (n = 4), and in the left hemisphere (n = 10) or bilateral (n = 6). Univariate analysis suggested use of lumbar drain (33.3% versus 57.2%, P = 0.04), inability to revascularize the left subclavian artery (16.7% vs 5.2%, P = 0.04) and number of implanted components (2.5 ± 1.2 vs 2.0 ± 0.97, P = 0.03) were associated with stroke. Multivariable analysis identified number of implanted components (OR 1.7, 95%CI 1.17-2.67 P = 0.00) and inability to revascularize the left subclavian artery as independent predictors of stroke. Stroke was associated with a higher perioperative mortality (27.8% vs 3.9%, P < 0.01). Stroke after TEVAR is primarily embolic in nature and related to both anatomic and procedural factors. This may have important implications for device development in the era of endovascular arch repair.<br /> (Copyright © 2022. Published by Elsevier Inc.)
- Subjects :
- Humans
Male
Middle Aged
Aged
Aged, 80 and over
Female
Endovascular Aneurysm Repair
Risk Factors
Treatment Outcome
Aorta, Thoracic surgery
Aortography methods
Retrospective Studies
Blood Vessel Prosthesis Implantation adverse effects
Endovascular Procedures adverse effects
Stroke etiology
Aortic Aneurysm, Thoracic surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1532-9488
- Volume :
- 35
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Seminars in thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 35091051
- Full Text :
- https://doi.org/10.1053/j.semtcvs.2021.08.030