Reevaluating the Need for Left Subclavian Artery Revascularization With Thoracic Endovascular Aortic Repair

Left subclavian artery coverage during thoracic endovascular aortic repair and risk of perioperative stroke or death

“…TEVARs analyzed in this study were performed at multiple centers for a variety of pathologies using heterogeneous patient selection criteria; perioperative adverse event rates associated with these procedures therefore may be more representative of outcomes associated with broader clinical application commercially available devices. Contemporary single-center retrospective analyses of TEVAR outcomes reported perioperative stroke and mortality rates of 3% to 10% and 0% to 10%, respectively, 2,4,[11][12][13][14][15][16][17] are comparable with the rates we observed and likely also reflect influences of broader patient selection criteria and a wider range of clinician experience. Several prior authors have attempted to ascertain the etiology of perioperative stroke after TEVAR and found similar determinants as were described in our analysis.…”

“…We identified a univariable association between simultaneous LSA revascularization and increased 30-day stroke risk, but this association was not significant in multivariable modeling; these observations resemble those of Kotelis et al, who noted lower stroke rates in the setting of LSA coverage without versus with revascularization. 2 Image-based evaluations of post-TEVAR neurologic complications have revealed anterior circulation stroke distributions in a significant proportion of patients 4,13,17 ; these anterior infarcts are presumably embolic in nature and therefore not necessarily avoided by pre-emptive revascularization. These inferences are supported by the findings of Cooper et al, who concluded that pre-emptive subclavian revascularization offers no protection against stroke associated with TEVAR.…”

Outcomes of Thoracic Endovascular Aortic Repair and Subclavian Revascularization Techniques

“…In contrast, a prior study and systematic review concluded that SCT compared to CSB had superior patency (84% vs. 98%) and freedom from complications (88 vs. 99%) (16). A potential explanation of these differences is that the aforementioned study evaluating LSA revascularization had a heterogeneous cohort of both patients undergoing TEVAR and patients undergoing treatment for LSA occlusive disease (6,(16)(17)(18)(19). A notable difference in our comparison groups was the expected distribution that CSB patients had a higher incidence of CABG, because the presence of a functioning internal mammary CABG is a crucial indication to select CSB over SCT.…”

Complication tardive d’un stentgraft thoracique

“…The second approach involves selective revascularization of the LSA based on estimating the risk of ischemic complications. 4 Recently, a study by Buth et al 5 from the European Collaborators on Stent/ Graft Techniques for Aortic Aneurysm Repair registry reported a significant fourfold increase risk of postoperative paraplegia with LSA coverage without revascularization. This finding, however, has been challenged by a recent study by Kotelis et al, 6 which found that the risk of paraplegia or stroke associated with intentional LSA coverage may be overestimated.…”