Background
Ischemic stroke is a devastating complication of thoracic endovascular aortic repair
(TEVAR). This risk may be higher in more proximal aneurysms that require arch manipulation.
The purpose of this study is to (1) describe 30-day stroke and death rates in patients
undergoing TEVAR, (2) compare stroke rates in patients undergoing TEVAR for arch versus
descending aneurysm pathology, and (3) identify predictive factors associated with
stroke after TEVAR.
Methods
The Vascular Quality Initiative registry was queried (2015–2021) for TEVAR procedures
performed for degenerative aneurysms. Our primary outcomes were any stroke or death
at 30 days. Patient-, procedure-, and hospital-level predictors of stroke were assessed
using multivariable Poisson regression.
Results
Among 3,072 patients with degenerative aneurysms (197 [6.4%] arch versus 2,875 [93.6%]
descending) treated with elective TEVAR, the median age was 73 years (interquartile
range 67–79) and 54.8% were male. Within the arch aneurysm group, there were 27.4%
zone 0, 22.8% zone 1, and 49.8% zone 2 interventions. Overall 30-day stroke and death
rates were 3.2% and 3.8%. The distribution of stroke events was bilateral (52.9%),
left carotid (20.7%), left vertebrobasilar (11.5%), right carotid (9.2%), and right
vertebrobasilar (5.7%). Although mortality was similar between groups, the rate of
ischemic stroke was higher for patients undergoing TEVAR for arch aneurysm versus
descending aneurysms (7.1% arch versus 2.9% descending, P = 0.001). Factors that were associated with ischemic stroke after TEVAR included
age (>79 years, relative risk [RR] 1.79, 95% confidence interval [CI] 1.08–2.98 vs.
<79 years), dependent functional status (RR 1.73, 95% CI 1.07–2.78), procedural time
(RR 1.25, 95% CI 1.15–1.36), and endovascular intervention for supra-aortic trunk
revascularization (RR 2.66, 95% CI 1.06–6.70 versus no intervention).
Conclusions
Ischemic stroke risk after TEVAR was increased for arch aneurysms compared to descending
aneurysms. More proximal zone coverage and endovascular interventions on the supra-aortic
trunks were associated with increasing risk for stroke. Adequate preparation for stroke
prevention is necessary prior to TEVAR with supra-aortic trunk revascularization.
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Article Info
Publication History
Published online: July 11, 2022
Accepted:
June 23,
2022
Received:
May 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Presented at Vascular & Endovascular Surgery Society (VESS), Snowmass, CO, January 27–30, 2021.
Conflicts of interest: The authors report no conflicts of interest or disclosures related to the content of this study.
Source of funding: RDL and MCC are supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health ( T32HL094293 ). MKE has received honoraria from Silk Road Medical, Inc. for service on the Roadster Clinical Events Committee, and from W. L. Gore & Associates as a TEVAR course director and Data Safety Monitoring Board member.
Identification
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