Riesgo de accidente cerebrovascular y supervivencia a medio plazo según la extensión proximal de la reparación...

Recent advancements in endovascular aortic repair (EVAR) have expanded treatment to increasingly proximal aortic segments, including the thoracic- and thoracoabdominal aorta as well as the arch. Coherent real-world data on stroke risk after all EVAR, stratified by proximal landing zone, and its impact on mid-term survival are scarce.

A population-based multi-registry retrospective analysis on prospectively collected data for all EVAR performed in Sweden from 2018 to 2023. Data were collected from the Swedish Vascular Registry (Swedvasc) and cross-referenced with the National Patient Registry, cause of death registry and the Stroke Registry. The effect of perioperative stroke on mid-term survival and its relation to proximal landing zone was analyzed.

Some 4842 EVARs were performed. Perioperative stroke occurred in 1.6% (n=79). Stroke risk was associated with proximal landing zone, with a rate of 22% in zone 0. In multivariable analysis, the odds ratio for stroke was 42 in zone 0 (95% CI: 19-94, P<0.001). The 30-day mortality was 24% (n=19) and 3.5% (n=169) in patients with and without perioperative stroke. This difference persisted over time, with a 4-year survival of 49% and 73% in patients with and without stroke (Hazard Ratio 2.2, 95% CI: 1.26-3.72, P<0.001).

Stroke is strongly associated with proximal landing zone, especially when landing proximal to the supra-aortic vessels. Perioperative stroke impacts patient survival and should be taken into consideration during patient selection, and efforts should be made to reduce the risk of stroke during proximal repair.