Morphological risk factors of stroke during thoracic endovascular aortic repair

Abstract

Stroke risk during TEVAR is directly associated with the atheroma burden of the aortic arch and the proximal landing zone. These factors should be considered during patient selection, planning, and implantation strategies of TEVAR.

Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies with the Conformable Thoracic Aortic Graft: Early and 2 year Results from a European Multicentre Registry

“…In several publications, the incidence of stroke is reported to be as high as 6%. 21,29e34 Kotelis et al 35 reported that stroke risk is associated with the burden of atheroma affecting the aortic arch. Emboli detected by transcranial Doppler occur at all stages of the TEVAR procedure and are associated with stroke.…”

Single Institution Experience with Hybrid Endovascular and Surgical Repairs Involving the Distal Aortic Arch

“…Lotfi et al reported 10% of patients having a history of transient ischemic attack/stroke, which is higher than the 4.7% with a history of stroke in the He et al population. Seeing that personal history of stroke and atheroma burden are notable risk factors for stroke, 7 this could account for disparities in stroke incidence between the populations. The rates of intraoperative and postoperative endoleaks in our study population are 9.3% (n ¼ 4) and 23.7%, respectively.…”

Thoracic endovascular aortic repair with left subclavian artery coverage without prophylactic revascularisation—early and midterm results

“…Secondly, only 43.4 % ( n  = 23) of patients had thoracic aortic aneurysm. Those two facts may indirectly indicate that our population had a low grade of either arch atheroma or thrombus and may explain the low incidence of CVA (an increased chance of CVA due to significant arch atheroma in patients >70 years of age was previously postulated [36, 38]).…”

“…Therefore, LSA coverage may be just an indirect marker of more advanced aortic disease with a higher hazard of embolisation. In fact, several recent papers explaining the reported stroke territory were found to support this theory [34–36]. The embolisation theory may also explain why numerous authors found LSA revascularisation to be ineffective in reducing the stroke rate [7, 12, 13, 23, 35, 37].…”