Autor:innen:
Dr. med. Beatrice Fiorucci | Klinikum der Universität München - Campus Großhadern | Germany
Prof. Dr. med. Tilo Kölbel | University Heart Center, University Hospital Eppendorf, Hamburg | Germany
Min Chen | Cook Research Incorporated | United States
Qing Zhou | Cook Research Incorporated | United States
Uni. Prof. Dr. med. Nikolaos Tsilimparis | Klinikum der Ludwig-Maximilians-Universität (LMU) München - Campus Großhadern | Germany
Background.
Neurologic complications remain some of the most serious complications of thoracic endovascular aortic repair (TEVAR). Using an aggregated dataset, we investigated early neurologic outcomes after TEVAR for multiple aortic diseases and assessed associated risk factors.
Methods.
The SUMMIT study includes aggregated data from six company-sponsored multicenter studies evaluating thoracic endografts of the Zenith platform (William Cook Europe, ApS, Bjaeverskov, Denmark). This post hoc analysis summarizes early (30-day) neurologic complications by disease types and identifies potential risk factors by logistic regression.
Results.
In total, 594 TEVAR patients (67% male; mean age 66±15 years) were treated for thoracic aortic aneurysms (TAA, N=329), thoracic ulcers (N=56), acute (N=126) and nonacute (N=33) type B aortic dissections (TBAD), and blunt thoracic aortic injuries (BTAI, N=50). The overall early stroke rate was 3.5% (acute TBAD 8.7%, BTAI 4.0%, TAA 2.4%, and 0% for others). The overall early paraplegia rate was 1.3% (acute TBAD 2.4%, TAA 1.5%, and 0% for others), and early paraparesis occurred in 2.5% of patients (TAA 3.3%, non-acute TBAD 3.0%, acute TBAD 2.4%, 0% for others). During TEVAR, the proximal edge of the endograft was above the left subclavian artery (LSA) in 65.6% of acute TBAD, 48.1% of nonacute TBAD, 44.0% of BTAI, 30.9% of thoracic ulcer, and 13.9% of TAA patients. Endograft landing above the LSA was associated with a higher stroke rate (6.8% vs. 2.3%, p=0.014). Among these patients, intraoperative LSA revascularization (bypass or transposition) were performed in 21% to preserve the antegrade flow, and these procedures did not show a significant effect on the risk of stroke (8.1% with revascularization vs. 6.4% without revascularization, p=0.72). In the multivariable analysis, only acute TBAD (vs. others, odds ratio [OR] 3.5, 95% confidence internal [CI] 1.4-8.5) and procedural time (hour, OR 1.3, 95% CI 1.0-1.7) were identified as risk factors for early stroke. Risk factors for early paraparesis or paraplegia were the number of endografts used (OR 2.4, 95% CI 1.3-4.5), age (year, OR 1.05, 95% CI 1.0-1.1) and preoperative serum creatinine (mg/dL, OR 1.3, 95% CI 1.1-1.6).
Conclusions.
The results from the SUMMIT study demonstrated that a higher stroke rate was associated with TEVAR for acute TBAD and prolonged procedural time, both surrogates of procedural complexity. There was a trend for a higher stroke rate in patients with endograft landing at Ishimaru zone 2 and above.