Trends in Stroke Severity and Incidence After Endovascular Repair for Descending Thoracic Aorta Diseases

Background: Perioperative stroke is a devastating complication after treatment of descending thoracic aorta disease (DTAD). As to whether developments in Thoracic Endovascular repair (TEVAR) influenced the overall stroke burden of patients with DTAD remains to be defined. This study investigated the current incidence and severity of procedure-related stroke in patients undergoing elective or emergency TEVAR. Methods: Patients with DTAD treated by TEVAR were questioned for perioperative stroke. Multivariable logistic regression models with backward variable selection were applied to investigate independent associations with perioperative stroke. Results: Between 2003-2015, 141 consecutive TEVAR (71.6% men;mean age 67.3+16.7years) were performed for DTAD: 58 (41.4%) were emergency procedures. The 30-day mortality was 9.2% (13/141) and 10 patients experienced procedure-related stroke. 30-day mortality was increased in patients with stroke: 23% vs. 5.5% (OR 5.2; 95%CI1.16-23.2;P=0.05). Stroke fatality was even more evident in elective repairs (P=0.049). Procedure-related stroke incidence was higher in emergency (13.3% vs. 2.6%;P=0-02), in procedures with left subclavian artery (LSA) coverage (21.4% vs. 3.5%;P=0.004) and in TEVAR performed before 2007 (15.6% vs 3.1%;P= 0.01). The relationship between increased stroke incidence and LSA coverage (35.7% vs. 6.5%;P=0.01) or procedure before 2007 (26.6% vs.5.1%;P=0.02) was particularly evident in TEVAR performed in emergency, while disappeared in elective repairs. Type of disease and age did not affect stroke risk. In multivariable regression, emergency of repair (OR,10.9; 95%CI,1.56-76.5; P=0.0.2), LSA coverage (OR,10.8; 95%CI 1.8-65.6;P=0.009) and procedure after 2007(OR 0.15; 95%CI 0.03-0.88;P=0.04) were confirmed as independently associated with procedure-related stroke as well as female sex (P=0.034). Conclusions: With developed technology the incidence of procedure-related stroke after TEVAR has declined. This trend was particularly achieved in emergency procedures where the prompt treatment may not allow for accurate planning. Nevertheless, stroke remains a devastating complication at high fatality risk for patients with DTAD even after elective TEVAR.