Cerebral embolization, silent cerebral infarction and neurocognitive decline after thoracic endovascular aortic repair

Abstract

This study demonstrates a high rate of cerebral embolization and neurocognitive decline affecting patients following TEVAR. Brain injury after TEVAR is more common than previously recognized, with cerebral infarction in more than 80 per cent of patients.

Single-Stage Hybrid Arch Repair for Patients with Shaggy Aorta

“…Indeed, cerebral embolization was reported following stent graft deployment, as well as contrast injection. 2 Thus, retrograde insertion of devices should be avoided if possible. Proximal arch landing is also a significant risk factor of cerebral embolism during TEVAR.…”

“…Proximal arch landing is also a significant risk factor of cerebral embolism during TEVAR. 2 Placement of an endograft in a segment of replaced Dacron aorta may reduce the risk of stroke, as well as reduce endoleak, because of mechanical stability and decreased remodeling of the landing zone. 5 We have some experience of two-stage hybrid repair for arch and descending aortic aneurysms.…”

“…Further, severe atheroma is a significant risk factor for cerebral infarction during TEVAR. 1,2 To resolve these problems, we developed a new method of single-stage hybrid total arch repair.…”

Novel Implementation of a Cerebral Protection System During Ascending Thoracic Endovascular Aortic Repair (TEVAR)

“…Despite rapid evolution of associated devices, materials, and techniques, however, TEVAR of the ascending aorta and aortic arch is currently reserved for patients with prohibitive risk for open surgical intervention [1]. Over 80% of patients undergoing TEVAR demonstrate post-procedural radiologic evidence of stroke associated with significant neurocognitive decline, and this incidence is estimated to be even higher in ascending TEVAR [2,3]. Increasingly widespread application of transcatheter aortic valve replacement (TAVR) has encouraged the development and implementation of cerebral protection devices for prevention of intra-operative stroke.…”

Commentary on “Robotic Arch Catheter Placement Reduces Cerebral Embolisation During Thoracic Endovascular Aortic Repair (TEVAR)”

“…The high number of TCD hits observed during this study parallels previous reports and places patients at risk of both clinical stroke and the cumulative effect of silent microemboli, which may cause long-term changes in memory and cognitive processing. 5,6 The potential role of using robotic systems in decreasing the embolisation rate remains to be defined; however, certainly seems worthy of further investigation.…”