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Predictive factors for cerebrovascular accidents after thoracic endovascular aortic repair

Giovanni Mariscalco1, Gabriele Piffaretti, Matteo Tozzi

  • 1Department of Surgical Sciences-Cardiac Surgery, Varese University Hospital, University of Insubria, Varese, Italy.

The Annals of Thoracic Surgery
|November 26, 2009
PubMed

Insights

Cerebrovascular accidents after thoracic endovascular aortic repair are predicted by incomplete Willis circle anatomy and coronary artery disease. Preoperative evaluation of cerebral circulation is crucial for patient selection.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Cardiology

Background:

  • Cerebrovascular accidents (CVAs) are significant complications following thoracic endovascular aortic repair (TEVAR).
  • Identifying predictors of CVAs after TEVAR is crucial for improving patient outcomes.

Purpose of the Study:

  • To determine predictors of cerebrovascular accidents after thoracic endovascular aortic repair.

Main Methods:

  • Prospective enrollment of 76 patients undergoing TEVAR between 2001 and 2008.
  • Hourly postoperative neurologic assessments were performed to detect deficits.
  • CVAs were diagnosed via clinical examination, imaging (CT/MRI), or autopsy.

Main Results:

  • CVAs occurred in 10.5% of patients (4 transient ischemic attacks, 4 major strokes).
  • Incomplete Willis circle anatomy (OR 17.19) and coronary artery disease (OR 6.86) were independent predictors of postoperative CVAs.
  • Hospital mortality was 9.2%, with no significant difference between patients with and without CVAs.

Conclusions:

  • Coronary artery disease and Willis circle anomalies are independent predictors of CVAs post-TEVAR.
  • Mandatory evaluation of arch vessels and cerebral vascularization is recommended for TEVAR candidates.
Abstract

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