Stroke Following Thoracic Endovascular Aortic Repair: Determinants, Short and Long Term Impact

Area of Science:

• Vascular Surgery
• Neurology
• Medical Device Development

Background:

• Thoracic endovascular aortic repair (TEVAR) is a minimally invasive treatment for thoracic aortic pathologies.
• Stroke is a significant complication following TEVAR, impacting patient outcomes.
• Understanding the factors contributing to stroke is crucial for improving TEVAR safety.

Purpose of the Study:

• To assess clinical and radiographic factors associated with stroke after TEVAR.
• To identify predictors of stroke in patients undergoing TEVAR.
• To explore the implications of stroke findings for future device development in endovascular arch repair.

Main Methods:

• Retrospective analysis of 479 patients undergoing TEVAR between 2006 and 2017.
• Assessment of clinical data and radiographic imaging (CT, Doppler US, angiography).
• Statistical analysis including univariate and multivariable logistic regression to identify stroke predictors.

Main Results:

• Stroke occurred in 3.8% of patients, predominantly embolic (77.8%).
• Independent predictors of stroke included the number of implanted components (OR 1.7) and inability to revascularize the left subclavian artery.
• Stroke was associated with significantly higher perioperative mortality (27.8% vs 3.9%).

Conclusions:

• Stroke after TEVAR is primarily embolic and influenced by anatomical and procedural factors.
• The number of implanted components and left subclavian artery revascularization are key predictors of stroke.
• These findings highlight the need for improved device design and procedural strategies to mitigate stroke risk during endovascular arch repair.