Carbon-dioxide versus saline flushing of thoracic aortic stents-grafts to reduce vascular brain infarcts: An observational study

Hanna, Lydia; Grover, Gagandeep Singh; Perera, Anisha H.; Chaudhery, Muzzaffer; Abdullah, Ammar; Singh, Abhinav; Bicknell, Colin; Modarai, Bijan; Hamady, Mohammad; Gibbs, Richard

doi:10.1016/j.ejvs.2019.12.013

Cited by 1 publication

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This has translated into the practice of 'CO 2 flushing' of TEVAR devices to replace air within the spaces of the delivery system and stent-graft with a less harmful gas [29]. Kolbel et al report a 3% stroke rate in 36 patients [54] while Hanna et al report an 7.5% stroke rate in 53 patients undergoing TEVAR with CO 2 flushing [55]. Notably, this latter study did demonstrate that only 39% of patients had evidence of new DW-MRI infarcts which contrasts to the 63-81% rate of infarction reported in other studies [7,8].…”

Section: Tevar Delivery System Flushing Techniquesmentioning

confidence: 99%

Brain Protection in the Endo-Management of Proximal Aortic Aneurysms

Hanna

Gibbs

2020

Hearts

Self Cite

View full text Add to dashboard Cite

Neurological brain injury (NBI) remains the most feared complication following thoracic endovascular aortic repair (TEVAR), and can manifest as clinically overt stroke and/or more covert injury, detected only on explicit neuropsychological testing. Microembolic signals (MES) detected on transcranial Doppler (TCD) monitoring of the cerebral arteries during TEVAR and the high prevalence and incidence of new ischaemic infarcts on diffusion-weighted magnetic resonance imaging (DW-MRI) suggests procedure-related solid and gaseous cerebral microembolisation to be an important cause of NBI. Any intervention that can reduce the embolic burden during TEVAR may, therefore, help mitigate the risk of stroke and the covert impact of ischaemic infarcts to the function of the brain. This perspective article provides an understanding of the mechanism of stroke and reviews the available evidence regarding potential neuroprotective strategies that target high-risk procedural steps of TEVAR to reduce periprocedural cerebral embolisation.

show abstract