Analysis of stroke after TEVAR involving the aortic arch.

Abstract

OBJECTIVE:

To analyse the incidence of stroke after thoracic endovascular aortic repair (TEVAR) for aortic arch disease.

METHODS:

In the last decade, 393 patients received TEVAR at our Institution; in 143 cases the aortic arch was involved (32 zones '0', 35 zones '1' and 76 zone '2'). The left subclavian artery (LSA) was revascularised selectively in 75 cases; the proximal LSA was ligated or occluded with a plug in 55 cases before endograft (EG) deployment.

RESULTS:

Initial clinical success, perioperative mortality, spinal cord ischaemia and stroke in TEVAR patients with or without arch involvement were, respectively, 86.7% vs. 94.4%, 4.2% vs. 2.4%, 2.1% vs. 3.6% and 2.8% vs. 1.2%. The stroke rate was 9.4% (P < 0.02) in 'zone 0', 0% in 'zone 1' and 1.3% in 'zone 2' with scans showing severe atheroma and/or thrombus in all cases. Stroke was observed in patients with 2.6% or without 2.9% LSA revascularisation; however, it was never observed in patients in whom the LSA was occluded before EG deployment and in 4.5% of patients in whom it was patent at the time of EG deployment.

CONCLUSIONS:

Stroke after TEVAR is not infrequent especially when the arch is involved. Careful patient selection together with a strategy to reduce embolisation such as occlusion of supra-aortic trunks before EG deployment may play a beneficial role.

• Authors: G Melissano, Y Tshomba, L Bertoglio, E Rinaldi, R Chiesa
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 43 Issue 3 Pg. 269-75 (Mar 2012) ISSN: 1532-2165 [Electronic] England
• PMID: 22240331 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Topics

• Adult
• Aged
• Aorta, Thoracic (surgery)
• Aortic Diseases (epidemiology, surgery)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation
• Causality
• Comorbidity
• Endovascular Procedures (adverse effects)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Length of Stay
• Male
• Middle Aged
• Postoperative Complications (classification, epidemiology, etiology)
• Prospective Studies
• Prosthesis Design
• Risk Factors
• Spinal Cord Ischemia (epidemiology, etiology)
• Stents
• Stroke (epidemiology)
• Treatment Outcome