Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results from the STEP Registry

Area of Science:

• Cardiovascular Surgery
• Neurology
• Radiology

Background:

• Endovascular repair of the aortic arch is increasingly common.
• Data on silent cerebral ischaemic events following these procedures are limited.

Purpose of the Study:

• To quantify the incidence and characteristics of silent brain infarctions (SBI) after endovascular aortic arch repair.
• To identify predictors of SBI in this patient population.

Main Methods:

• A multicentre retrospective cohort study using the STEP registry (NCT04489277).
• Included 91 patients who underwent endovascular aortic arch repair with deployment in Ishimaru zones 0-3.
• Cerebral diffusion-weighted magnetic resonance imaging (DW-MRI) was performed within seven days post-procedure to detect new SBI. Endografts were flushed with carbon dioxide before implantation.

Main Results:

• A total of 245 SBI were detected in 45 patients (50%) within 30 days.
• No deaths or clinical strokes occurred.
• Deployment in zones 0-1, branched/fenestrated endografts, prosthesis diameter ≥40 mm, and urgent procedures were associated with SBI on univariable analysis.
• Urgent procedure was an independent predictor of SBI on multivariable analysis (p=0.002).

Conclusions:

• Silent brain infarctions are frequent after endovascular aortic arch repair, despite the absence of clinical strokes.
• Urgent procedures are a significant risk factor for developing SBI.
• Novel strategies are required to minimize the risk of embolization during these interventions.