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Cerebral microbleeds following thoracic endovascular aortic repair
Wolf Eilenberg1,2, Matthias Bechstein3, Philippe Charbonneau4
1German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Background:
Stroke and neurological injury are a complication of thoracic endovascular aortic repair (TEVAR). Cerebral microbleeds (CMBs) are common in patients with white matter damage to the brain secondary to chronic vasculopathy. The aim of this study was to examine the occurrence of CMBs after TEVAR, and to evaluate their association with patient and procedural factors.
Methods:
Patients who underwent TEVAR between September 2018 and January 2020 in two specialist European aortic centres were analysed. All patients underwent postoperative susceptibility-weighted MRI. The location and number of CMBs were identified, and analysed with regard to procedural aspects, clinical outcome, and Fazekas score as an indicator of pre-existing vascular leucoencephalopathy.
Results:
Some 91 patients were included in the study. A total of 1531 CMBs were detected in 58 of 91 patients (64 per cent). In the majority of affected patients, CMBs were found bilaterally (79 per cent). Unilateral CMBs in the right or left hemisphere occurred in 16 and 5 per cent of patients respectively (P < 0.001). More CMBs were found in the middle cerebral than in the vertebrobasilar/posterior and anterior cerebral artery territories (mean(s.d.) 3.35(5.56) versus 2.26(4.05) versus 0.97(2.87); P = 0.045). Multivariable analysis showed an increased probability of CMBs after placement of TEVAR stent-grafts with a proximal diameter of at least 40 mm (odds ratio (OR) 6.85, 95 per cent c.i. 1.65 to 41.59; P = 0.007) and in patients with a higher Fazekas score on postoperative T2-weighted MRI (OR 2.62, 1.06 to 7.92; P = 0.037).
Conclusion:
CMBs on postoperative MRI are common after endovascular repair in the aortic arch. Their occurrence appears to be associated with key aspects of the procedure and pre-existing vascular leucoencephalopathy.
Insights
Cerebral microbleeds (CMBs) are common after thoracic endovascular aortic repair (TEVAR), affecting 64% of patients. Larger stent-graft diameter and higher pre-existing vascular leucoencephalopathy scores increase CMB risk.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Radiology
Background:
- Thoracic endovascular aortic repair (TEVAR) can lead to stroke and neurological injury.
- Cerebral microbleeds (CMBs) are frequently observed in patients with white matter damage due to chronic vasculopathy.
Purpose of the Study:
- To investigate the incidence of CMBs following TEVAR.
- To identify patient and procedural factors associated with CMB occurrence after TEVAR.
Main Methods:
- Analysis of 91 patients undergoing TEVAR between September 2018 and January 2020.
- Postoperative susceptibility-weighted MRI to detect and quantify CMBs.
- Correlation of CMBs with procedural details and Fazekas scores for pre-existing vascular leucoencephalopathy.
Main Results:
- 64% of patients (58/91) developed CMBs, with 1531 total detected.
- CMBs were predominantly bilateral (79%) and more frequent in the middle cerebral artery territory.
- Increased risk of CMBs was associated with TEVAR stent-grafts ≥40 mm proximal diameter (OR 6.85) and higher postoperative Fazekas scores (OR 2.62).
Conclusions:
- Postoperative MRI reveals CMBs are a common finding after aortic arch TEVAR.
- The presence of CMBs is linked to specific procedural characteristics and pre-existing cerebrovascular disease.
