Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results from the STEP Registry

Charbonneau, Philippe; Kölbel, Tilo; Rohlffs, Fiona; Eilenberg, Wolf; Planché, O.; Bechstein, Matthias; Ristl, Robin; Greenhalgh, Roger M.; Haulon, Stéphan

doi:10.1016/j.ejvs.2020.11.021

Cited by 34 publications

(15 citation statements)

References 30 publications

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“…Silent brain infarctions following endovascular repair of the aortic arch were recently reported by Charbonneau et al [ 13 ] They found the incidence of silent CI was 50% (45 of 91), although all endografts were flushed with carbon dioxide before implantation. A study by Eleshra et al [ 14 ] indicated that carbon dioxide flushing effectively exchanged trapped air for less harmful gas in endografts.…”

Section: Discussionmentioning

confidence: 97%

Actual incidence of cerebral infarction after thoracic endovascular aortic repair: a magnetic resonance imaging study

Kotani

Inoue

Oki

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES The actual incidence of cerebral infarction (CI), including asymptomatic infarction, owing to thoracic endovascular aortic repair (TEVAR) has not been reported in detail. This study was performed to investigate the incidence of post-TEVAR CI by using diffusion-weighted magnetic resonance imaging (DW-MRI) and to determine the risk factors for both symptomatic and asymptomatic CI. METHODS We examined 64 patients undergoing TEVAR at our institute between April 2017 and November 2020. Aortic atheroma was graded from 1 to 5 by preoperative computed tomography. Cerebral DW-MRIs were conducted 2 days after the procedure to diagnose postoperative CI. RESULTS A total of 44 new foci were detected by post-interventional cerebral DW-MRI in 22 patients (34.4%). Only one patient developed a symptomatic stroke (1.6%), and TEVAR was successfully completed in all cases. Debranching of the aortic arch and left subclavian artery occlusion with a vascular plug was performed in 19 (29.7%) and 12 (18.8%) patients, respectively. The number of patients with proximal landing zones 0–2 was significantly higher in the CI group than in the non-CI group (68.2% vs 11.9%; P < 0.001). The following risk factors were identified for asymptomatic CI: aortic arch debranching (P < 0.001), left subclavian artery occlusion (P = 0.001) and grade 4/5 aortic arch atheroma (P = 0.048). CONCLUSIONS Over one-third of the patients examined by cerebral DW-MRI after TEVAR were diagnosed with CI. High-grade atheroma and TEVAR landing in zone 0–2 were found to be positively associated with asymptomatic CI. Clinical trial registration 02-014.

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Section: Discussionmentioning

confidence: 97%

Actual incidence of cerebral infarction after thoracic endovascular aortic repair: a magnetic resonance imaging study

Kotani

Inoue

Oki

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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“…The DPARSF software based on MATLAB platform was used to preprocess the resting state fMRI data. The following steps were carried out [ 19 ]: (1) Deletion of previous time: the signal was unstable at the beginning of the collection, and the participants had to adapt to the environment, so it was generally necessary to delete the images taken in the first 10 time stages. (2) Section time correction: MRI images were scanned layer by layer, so the acquisition time of each layer was different.…”

Section: Methodsmentioning

confidence: 99%

Fast Independent Component Analysis Algorithm-Based Functional Magnetic Resonance Imaging in the Diagnosis of Changes in Brain Functional Areas of Cerebral Infarction

Zhang

Xiao

et al. 2021

Contrast Media & Molecular Imaging

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The aim of this study was to analyze the application value of functional magnetic resonance imaging (FMRI) optimized by the fast independent component correlation algorithm (ICA algorithm) in the diagnosis of brain functional areas in patients with lumbar disc herniation (LDH). An optimized fast ICA algorithm was established based on the ICA algorithm. 50 patients with cerebral infarction were selected as the research objects, and 30 healthy people were selected as the control group. The 50 patients from the observation group were examined by fMRI based on Fast ICA algorithm, while the control group was tested by fMRI based on the routine ICA algorithm. The performances of the two algorithms, the analysis results of the two groups of brain functional areas, cerebral blood flow (CBF), resting state functional connectivity (rsFC), behavioral data, and image data correlation of patients were compared. The results showed that the sensitivity, specificity, and accuracy of Fast ICA algorithm were 97.83%, 89.52%, and 96.27%, respectively, which in the experimental group were greatly better than the control group (88.73%, 72.19%, and 89.72%), showing statistically significant differences ( P < 0.05 ). The maximum Dice coefficient of FAST ICA algorithm was 0.967, and FAST ICA algorithm was better obviously than the traditional ICA algorithm ( P < 0.05 ). The cerebral blood flow of the healthy superior frontal gyrus (SFG) and healthy superior marginal gyrus (SMG) of the observation group with good motor function recovery were 1.02 ± 0.22 and 1.53 ± 0.61, respectively; both indicators showed an increasing trend, and those in the experimental group were much higher in contrast to the control group, showing statistically obvious differences ( P < 0.05 ). Besides, the detection results of cerebral blood flow (CBF) in the healthy SFG and healthy SMG were negatively correlated with the results of connection test B. In summary, the fMRI based on the Fast ICA algorithm showed a good diagnostic effect in the changes of brain functional areas in patients with cerebral infarction. The experimental results showed that the cerebral blood flow in the brain area was related to motor or cognitive function. The results of this study provided a reliable reference for the examination and diagnosis of brain functional areas in patients with cerebral infarction.

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“…Recent studies showed that the rate of SBI after TEVAR is even higher and present in 50% -80% of patients [8,9] what can be associated with neurocognitive decline in the long term. Release of air from the stent-graft system has been documented after standard flushing and is discussed as one of the reasons for cerebral embolism [10,11] . Significant reduction of the released air can be achieved by adding CO2 to the standard flushing protocol [12] .…”

Section: Introductionmentioning

confidence: 99%

The Carbon Dioxide Flushing Technique: A Novel Approach Using Oxygen Measurements to Evaluate the Elimination of Room Air from Thoracic Stent-Grafts

Arulrajah

Kölbel

Panuccio

et al. 2023

ijirms

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Background: The study evaluates a novel technique using oxygen measurements to indirectly evaluate the behavior of carbon dioxide (CO2) in the residual gas released by thoracic stent-grafts and to better understand the mechanism of the CO2 flushing technique. Methods: Ten Zenith TX2 ProForm thoracic stent-grafts (ZDEG-PT-34-199-PF, Cook Medical, Bjæverskov, Denmark) were equally divided into 2 groups (Group A and B). Group A was flushed with 60 ml of 0.9% saline. Group B was flushed with 100% carbon dioxide gas followed by 60 ml of 0.9% saline. The stent-grafts were deployed into a plastic tube that was placed and fixated to the bottom of a translucent container filled with water to collect the residual air released by the stent-grafts. Oxygen (O2) concentration and gas volume were measured in the released gas. Results: The oxygen concentration was significant (p<0.001) lower after additional carbon dioxide flush compared to standard flush (18.5% vs 19.6%). Furthermore, the absolute oxygen volume was significantly lower after additional carbon dioxide flush than without (0.18 ml vs 0.32 ml, p=0.041). The total amount of released gas appeared lower with carbon dioxide flush than without (0.98 ml vs 1.65, P=0.058). Conclusions: CO2 absorption into saline and replacement of room air by CO2 inside the stent-graft may lead to a reduction of released gas during stent-graft deployment in an experimental setting.

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Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results from the STEP Registry

Cited by 34 publications

References 30 publications

Actual incidence of cerebral infarction after thoracic endovascular aortic repair: a magnetic resonance imaging study

Actual incidence of cerebral infarction after thoracic endovascular aortic repair: a magnetic resonance imaging study

Fast Independent Component Analysis Algorithm-Based Functional Magnetic Resonance Imaging in the Diagnosis of Changes in Brain Functional Areas of Cerebral Infarction

The Carbon Dioxide Flushing Technique: A Novel Approach Using Oxygen Measurements to Evaluate the Elimination of Room Air from Thoracic Stent-Grafts

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