Philipp Kahlert1, Holger Eggebrecht2, Rolf A Jánosi2, Heike A Hildebrandt2, Björn Plicht2, Konstantinos Tsagakis3, Christoph Moenninghoff4, Felix Nensa4, Petra Mummel5, Gerd Heusch6, Heinz G Jakob3, Michael Forsting4, Raimund Erbel2, Marc Schlamann4. 1. Department of Cardiology, West-German Heart Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany. Electronic address: philipp.kahlert@uk-essen.de. 2. Department of Cardiology, West-German Heart Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany. 3. Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany. 4. Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, University Duisburg-Essen, Essen, Germany. 5. Department of Neurology, Essen University Hospital, University Duisburg-Essen, Essen, Germany. 6. Institute for Pathophysiology, Essen University Hospital, University Duisburg-Essen, Essen, Germany.
Abstract
BACKGROUND: The risk of clinically apparent, periprocedural stroke after thoracic endovascular aortic repair (TEVAR) due to dislodgement and embolization of aortic debris from intravascular manipulation of guidewires, catheters, and large-bore delivery systems ranges between 2% and 6% and has been associated with increased postoperative mortality. The rate of clinically silent cerebral ischemia is yet unknown, but may be even higher. METHODS: Nineteen patients (13 male, 6 female) who underwent TEVAR were included into this descriptive study. Periprocedural apparent and silent cerebral ischemia was assessed by daily clinical neurologic assessment and serial cerebral diffusion-weighted magnetic resonance imaging (DW-MRI) at baseline and 5 days (median, interquartile range: 3.5) after the procedure. RESULTS: The TEVAR was successful in all patients without immediate clinically apparent neurologic deficits. Postinterventional cerebral DW-MRI detected a total of 29 new foci of restricted diffusion in 12 of 19 TEVAR patients (63%). Lesions were usually multiple (1 to 6 lesions per patient) and ranged in size between 15 mm3 and 300 mm3; 16 lesions were found in the left hemisphere, 13 lesions in the right hemisphere. Overstenting of the left subclavian artery was performed in 8 cases, but was not associated with lateralization of lesions. There were no additional apparent neurologic events during the in-hospital period. CONCLUSIONS: Thoracic endovascular aortic repair resulted in a high incidence of new foci of restricted diffusion on cerebral DW-MRI in a pattern suggestive of periprocedural embolization. Although multiple lesions per patients were found, these lesions were not associated with apparent neurologic deficits during the in-hospital period. Further developments in TEVAR should be directed toward reducing the risk of periprocedural cerebral embolization.
BACKGROUND: The risk of clinically apparent, periprocedural stroke after thoracic endovascular aortic repair (TEVAR) due to dislodgement and embolization of aortic debris from intravascular manipulation of guidewires, catheters, and large-bore delivery systems ranges between 2% and 6% and has been associated with increased postoperative mortality. The rate of clinically silent cerebral ischemia is yet unknown, but may be even higher. METHODS: Nineteen patients (13 male, 6 female) who underwent TEVAR were included into this descriptive study. Periprocedural apparent and silent cerebral ischemia was assessed by daily clinical neurologic assessment and serial cerebral diffusion-weighted magnetic resonance imaging (DW-MRI) at baseline and 5 days (median, interquartile range: 3.5) after the procedure. RESULTS: The TEVAR was successful in all patients without immediate clinically apparent neurologic deficits. Postinterventional cerebral DW-MRI detected a total of 29 new foci of restricted diffusion in 12 of 19 TEVARpatients (63%). Lesions were usually multiple (1 to 6 lesions per patient) and ranged in size between 15 mm3 and 300 mm3; 16 lesions were found in the left hemisphere, 13 lesions in the right hemisphere. Overstenting of the left subclavian artery was performed in 8 cases, but was not associated with lateralization of lesions. There were no additional apparent neurologic events during the in-hospital period. CONCLUSIONS: Thoracic endovascular aortic repair resulted in a high incidence of new foci of restricted diffusion on cerebral DW-MRI in a pattern suggestive of periprocedural embolization. Although multiple lesions per patients were found, these lesions were not associated with apparent neurologic deficits during the in-hospital period. Further developments in TEVAR should be directed toward reducing the risk of periprocedural cerebral embolization.
Authors: Mario D'Oria; Kevin Mani; Randall DeMartino; Martin Czerny; Konstantinos P Donas; Anders Wanhainen; Sandro Lepidi Journal: Interact Cardiovasc Thorac Surg Date: 2021-05-10
Authors: Vinay Garg; Mark D Peterson; Michael Wa Chu; Maral Ouzounian; Roderick Gg MacArthur; John Bozinovski; Ismail El-Hamamsy; F Victor Chu; Ankit Garg; Judith Hall; Kevin E Thorpe; Natasha Dhingra; Hwee Teoh; Thomas R Marotta; David A Latter; Adrian Quan; Muhammad Mamdani; Peter Juni; C David Mazer; Subodh Verma Journal: BMJ Open Date: 2017-06-10 Impact factor: 2.692