Analysis of stroke after TEVAR involving the aortic arch

G. Melissano, Y. Tshomba, L. Bertoglio, E. Rinaldi, R. Chiesa

Research output: Contribution to journalArticle

66 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)269-275
Number of pages7
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume43
Issue number3
DOIs
Publication statusPublished - Mar 2012

Fingerprint

Thoracic Aorta
Subclavian Artery
Thorax
Stroke
Spinal Cord Ischemia
Aortic Diseases
Atherosclerotic Plaques
Patient Selection
Thrombosis
Mortality
Incidence

Keywords

  • Aortic arch
  • Cerebral embolism
  • Endovascular aortic repair
  • Hybrid repair
  • Stroke
  • Thoracic stent-graft

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Analysis of stroke after TEVAR involving the aortic arch. / Melissano, G.; Tshomba, Y.; Bertoglio, L.; Rinaldi, E.; Chiesa, R.

In: European Journal of Vascular and Endovascular Surgery, Vol. 43, No. 3, 03.2012, p. 269-275.

Research output: Contribution to journalArticle

Melissano, G. ; Tshomba, Y. ; Bertoglio, L. ; Rinaldi, E. ; Chiesa, R. / Analysis of stroke after TEVAR involving the aortic arch. In: European Journal of Vascular and Endovascular Surgery. 2012 ; Vol. 43, No. 3. pp. 269-275.
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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.",
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