Prognosis and Risk Factors of Stroke After Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection

Zha, Zhengbiao; Pan, Youmin; Zheng, Zhi; Wei, Xiang

doi:10.3389/fcvm.2021.787038

Cited by 12 publications

(8 citation statements)

References 14 publications

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“…CBVD occurred during the perioperative period for 3% of patients. Literature showed similar results (2.0% to 9.3%) [12][13][14][15][16][17][18][19][20][21][22]. Moreover, international medical literature shows an overall incidence of TIA between 11.5-13% on the long-term follow-up.…”

Section: Neurological Outcomesmentioning

confidence: 52%

Long-Term Outcomes in Patients Undergoing Thoracic Endovascular Aortic Repair. Single Center Experience

Dokollari,

Sicouri,

Torregrossa

et al. 2023

Preprint

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Background: To analyze long-term outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). Methods: All consecutive 97 patients undergoing TEVAR between September 2014 and September 2022 were included in the study. Primary outcome was long-term incidence of overall death and major adverse cardiovascular and cerebrovascular events (MACCE). Results: Mean age was 70.4 years, and 22(23.2%) had cerebrovascular disease (CBVD). A total of 49(51.6%) of patients had prior cardiac surgery intervention and 8(8.5%) had prior aortic valve replacement. Twenty-eight patients(28.8%) presented with aortic dissection, 60(61.8%) had aortic aneurysm, 4(4.1%) had intramural hematoma, and 5(5.1%) had other presentations. An emergent procedure was performed in 6(6.2%) patients, an urgent procedure in 37(38.1%) patients and 54(55.7%) patients had an elective procedure. Intraoperatively, 78.3% had percutaneous TEVAR, 5.1% had ministernotomy TEVAR, while 10.3% had concomitant full sternotomy TEVAR repair. Hospital mortality was 7 patients(7.2%). At 8-years follow-up, 76% were alive, 25.8% had MACCE, 21.6% were diagnosed with endoleaks(13 patients type II and 2 patients type 1) while 10.3% un-derwent repeat intervention. Conclusions: This single center experience in patients undergoing TEVAR evidenced good short and long-term survival and MACCE. Nonetheless, almost half of the patients underwent an ur-gent/emergent procedure, clinical results were favourable for TEVAR.

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Section: Neurological Outcomesmentioning

confidence: 52%

Long-Term Outcomes in Patients Undergoing Thoracic Endovascular Aortic Repair. Single Center Experience

Dokollari,

Sicouri,

Torregrossa

et al. 2023

Preprint

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“…Even after LSA was reconstruction, the incidence of stroke was 5.3% [22] . In this study, the incidence of transient neurological dysfunction (TND) [23 ] was lower than the average level of TEVAR surgery. Compared to other surgical methods, the duration of cerebral ischemia can be reduced by an LCCA-LSA shunt before stent implantation, and the incidence of stroke may also be related to this.…”

Section: Discussionmentioning

confidence: 72%

Application of left common carotid-left subclavian artery shunt for reconstruction of left subclavian artery in TEVAR of type B aortic dissection with insufficient proximal anchoring area: 10 years of single-center experience

Wang

Song

Wei

et al. 2023

Preprint

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Objectives：In thoracic endovascular aortic repair(TEVAR) of type B aortic dissection (TBAD) , left common carotid-left subclavian artery（LCCA-LSA) shunt is a feasible method to reconstruct left subclavian artery (LSA) in order to provide enough proximal anchoring area. The purpose of this study was to evaluate the safety and early efficacy of LCCA-LSA shunt in the reconstruction of LSA in TEVAR of TBAD with insufficient proximal anchoring area. Methods：The clinical data of 63 patients (mean age 52.3 ±11.6years, 54 males and 9 females) with TBAD who underwent LCCA-LSA shunt to reconstruct LSA in TEVAR from January 2010 to December 2021 were analyzed retrospectively. The technical success rate, operation time, complications such as leakage, stroke, hemorrhage, spinal cord ischemia, pulmonary infection, perioperative death and readmission were recorded and analyzed retrospectively. Results：A total of 63 patients were included, 60 cases (95.2%) of LCCA-LSA shunt, 3 cases (4.8%) of LSA-LCCA transposition; 10 cases (15.9%) underwent carotid-carotid bypass surgery at the same time, 9 cases (14.3%) underwent ligating LSA of proximal LVA surgery and 15 cases (23.8%) underwent embolization of LSA root surgery. The average operation time is 323.7±91.6 min. The results of intraoperative angiography showed that all the LSA were reserved, therefore the technical success rate was 100%. Within 1 month after operation, 11 cases (17.5%) had complications occurred, 9 cases(14.3%) were cured and discharged from hospital, 1 case (1.6%) had sequela of cerebral infarction and 1 case (1.6%) died at 18 days after the surgery. During the follow-up period, 6 patients (9.5%) were readmitted to hospital because of new distal rupture or/and internal leakage, all of which were cured and discharged. Conclusion：For TBAD patients without enough proximal anchoring area, LCCA-LSA shunt for LSA reconstruction has a high technical success rate, low mortality and low incidence of residual complications, which is a good choice and has unique advantages. However, medium and longterm safety and efficacy still need a large number of sample studies.

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“…Twenty-six articles were chosen for further full-text evaluation according to titles and abstracts. Finally, 10 articles with 7,849 individuals were included ( Romijn et al, 2023 ; Borghese et al, 2023 ; Niu et al, 2023 ; Zha et al, 2021 ; An et al, 2021 ; Naazie et al, 2022 ; Lu et al, 2020 ; Janczak et al, 2019 ; Zakko et al, 2014 ; Khoynezhad et al, 2007 ). The study screening flow diagram is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…S2 . Among these studies, three reported the BMI of patients who experienced adverse events after TEVAR or not ( Niu et al, 2023 ; An et al, 2021 ; Zakko et al, 2014 ), five reported the ORs or HRs of obesity and the incidence of adverse events ( Romijn et al, 2023 ; Borghese et al, 2023 ; Naazie et al, 2022 ; Lu et al, 2020 ; Khoynezhad et al, 2007 ), and four reported the incidence of adverse events in patients with or without obesity ( Borghese et al, 2023 ; Zha et al, 2021 ; Janczak et al, 2019 ; Khoynezhad et al, 2007 ). According to the NOS, all enrolled studies were considered high quality ( Table S3 ).…”

Section: Resultsmentioning

confidence: 99%

The effect of obesity on the outcome of thoracic endovascular aortic repair: a systematic review and meta-analysis

Li,

Zhang,

Huang

et al. 2024

PeerJ

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Background Obesity is a well-known predictor for poor postoperative outcomes of vascular surgery. However, the association between obesity and outcomes of thoracic endovascular aortic repair (TEVAR) is still unclear. This systematic review and meta-analysis was performed to assess the roles of obesity in the outcomes of TEVAR. Methods We systematically searched the Web of Science and PubMed databases to obtain articles regarding obesity and TEVAR that were published before July 2023. The odds ratio (OR) or hazard ratio (HR) was used to assess the effect of obesity on TEVAR outcomes. Body mass index (BMI) was also compared between patients experiencing adverse events after TEVAR and those not experiencing adverse events. The Newcastle–Ottawa Scale was used to evaluate the quality of the enrolled studies. Results A total of 7,849 patients from 10 studies were included. All enrolled studies were high-quality. Overall, the risk of overall mortality (OR = 1.49, 95% CI [1.02–2.17], p = 0.04) was increased in obese patients receiving TEVAR. However, the associations between obesity and overall complications (OR = 2.41, 95% CI [0.84–6.93], p = 0.10) and specific complications were all insignificant, including stroke (OR = 1.39, 95% CI [0.56–3.45], p = 0.48), spinal ischemia (OR = 0.97, 95% CI [0.64–1.47], p = 0.89), neurological complications (OR = 0.13, 95% CI [0.01–2.37], p = 0.17), endoleaks (OR = 1.02, 95% CI [0.46–2.29], p = 0.96), wound complications (OR = 0.91, 95% CI [0.28–2.96], p = 0.88), and renal failure (OR = 2.98, 95% CI [0.92–9.69], p = 0.07). In addition, the patients who suffered from postoperative overall complications (p < 0.001) and acute kidney injury (p = 0.006) were found to have a higher BMI. In conclusion, obesity is closely associated with higher risk of mortality after TEVAR. However, TEVAR may still be suitable for obese patients. Physicians should pay more attention to the perioperative management of obese patients.

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Prognosis and Risk Factors of Stroke After Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection

Cited by 12 publications

References 14 publications

Long-Term Outcomes in Patients Undergoing Thoracic Endovascular Aortic Repair. Single Center Experience

Long-Term Outcomes in Patients Undergoing Thoracic Endovascular Aortic Repair. Single Center Experience

Application of left common carotid-left subclavian artery shunt for reconstruction of left subclavian artery in TEVAR of type B aortic dissection with insufficient proximal anchoring area: 10 years of single-center experience

The effect of obesity on the outcome of thoracic endovascular aortic repair: a systematic review and meta-analysis

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