Risk Factors for Perioperative Stroke After Thoracic Endovascular Aortic Repair

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

“…Stroke was observed in 2.5% of the patients in the STARZ TX2 clinical trial (469) and 3.6% in the Talent VALOR trial (482). It has been reported to be as high as 8% in other studies (474,492). Most strokes occur as a result of atheroemboli from the transverse aortic arch with manipulation of the guidewires and device in the arch vessels (474).…”

Aortic Atherosclerosis as an Embolic Source

“…Large atherosclerotic plaques and intraluminal thrombi of the aorta may increase the risk of embolic stroke during manipulation of guidewires and catheters [ 27 ]. Plaque disruption due to these procedures may significantly increase the morbidity and mortality of aortic interventions such as transcatheter aortic valve insertion [ 28 ].…”

Penetrating aortic ulcer

“…Due to evolving device technology-no longer requiring anything except a guide wirethe occurrence of stroke has decreased, as excessive manipulation across a diseased arch can be prevented [30,62]. Nevertheless, in patients with thoracic PAU and high grade atheroma of the aortic arch, care has to be taken to minimize the risk of embolic stroke events caused by guide wire manipulation during thoracic stentgraft implantation [28].…”