Cerebral embolic protection during endovascular arch replacement.

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Open aortic arch repair is highly invasive, posing significant risks for high-risk patients.
• Near-total and hybrid approaches offer less invasive alternatives for aortic arch disease.
• These methods avoid extracorporeal circulation and hypothermic circulatory arrest, benefiting high-risk individuals.

Purpose of the Study:

• To review current near-total and hybrid approaches for aortic arch pathology.
• To discuss the epidemiology, procedures, and mitigation strategies for stroke in these interventions.
• To address current embolic protection methods and future directions in aortic arch repair.

Main Methods:

• Review of current literature on minimally invasive aortic arch repair techniques.
• Analysis of procedural advantages and risks associated with near-total and hybrid approaches.
• Examination of stroke incidence and embolic protection strategies in endovascular aortic arch repair.

Main Results:

• Near-total and hybrid approaches reduce invasiveness and are suitable for high-risk patients.
• Dedicated medical devices for aortic arch repair are rapidly evolving.
• Stroke, primarily due to cerebral embolism, remains a significant complication of endovascular aortic arch repair.

Conclusions:

• Minimally invasive techniques provide viable options for complex aortic arch pathologies.
• Continued development of devices and embolic protection is crucial for improving outcomes.
• Addressing stroke risk is paramount for the widespread adoption of endovascular aortic arch repair.