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Updated: Aug 31, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Neurological Complications after Urgent TEVAR: Risk Factors and Long-Term Outcomes
Ayman Alkassem1, Salah Yassine1, Umar Sadat2
1Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Background:
To evaluate the incidence, associated factors, and long-term outcomes of neurological complications following urgent thoracic endovascular aortic repair (TEVAR).
Methods:
This retrospective single-center study included consecutive patients undergoing urgent TEVAR between 2014 and 2025. Primary outcomes were cerebrovascular events, spinal cord ischemia (SCI) and mortality. Associations with clinical, anatomical, and procedural variables were assessed using logistic regression. Survival was estimated using Kaplan-Meier analysis.
Results:
A total of 140 patients (median age 70 years [interquartile range {IQR}: 60-76]; 61% male) were included. Acute aortic dissection was the most common indication (53%), followed by ruptured (19%) and symptomatic (18%) thoracic aneurysm. Within 30 days, cerebrovascular event occurred in 14 (10%) patients, and SCI in 13 (9%) patients; 5 patients (4%) developed both complications. Most cerebrovascular events were ischemic strokes (9%). During follow-up, late stroke and SCI were uncommon (3% and 2%, respectively). On univariable analysis, greater aortic coverage was associated with SCI, cerebrovascular events, and 30-day mortality. Left subclavian artery (LSA) revascularization was associated with a lower incidence of SCI (P = 0.04). Estimated overall survival was 83%, 73%, and 66% at 1, 3, and 5 years, respectively.
Conclusion:
Urgent TEVAR is associated with a moderate incidence of early neurological complications and acceptable long-term survival. Greater aortic coverage and LSA management were associated with neurological outcomes in unadjusted analyses. These findings support careful consideration of aortic coverage and collateral perfusion during procedural planning.
