Left Subclavian Arterial Coverage and Stroke During Thoracic Aortic Endografting: A Systematic Review

Stroke is a devastating complication of thoracic endovascular aortic repair (TEVAR). Whether left subclavian artery (LSA) coverage and LSA revascularization affect stroke rate is debated. Whether patients with aneurysms or dissections undergoing TEVAR have higher stroke rates is also debated. We rep...

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Published inThe Annals of thoracic surgery Vol. 101; no. 1; pp. 381 - 389
Main Authors Waterford, Stephen D., MD, MS, Chou, Daisy, MD, Bombien, René, MD, PhD, Uzun, Isil, MD, Shah, Aamir, MD, Khoynezhad, Ali, MD, PhD
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier Inc 01.01.2016
Subjects
Aorta, Thoracic - surgery
Aortic Diseases - surgery
Blood Vessel Prosthesis
Cardiothoracic Surgery
Endovascular Procedures - adverse effects
Humans
Intraoperative Complications
Stents
Stroke - etiology
Subclavian Artery - surgery
Surgery
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Summary:Stroke is a devastating complication of thoracic endovascular aortic repair (TEVAR). Whether left subclavian artery (LSA) coverage and LSA revascularization affect stroke rate is debated. Whether patients with aneurysms or dissections undergoing TEVAR have higher stroke rates is also debated. We report a systematic review of 63 studies comprising more than 3,000 patients. We conclude that stroke risk after TEVAR is increased by LSA coverage, and that LSA revascularization reduces stroke risk. LSA revascularization may lower the rate of posterior stroke. TEVAR for aneurysm is associated with increased stroke risk compared to TEVAR for dissection.
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ISSN:0003-4975
1552-6259
DOI:10.1016/j.athoracsur.2015.05.138