Predictive factors for cerebrovascular accidents after thoracic endovascular aortic repair.
BACKGROUND
Cerebrovascular accidents are devastating and worrisome complications after thoracic endovascular aortic repair. The aim of this study was to determine cerebrovascular accident predictors after thoracic endovascular aortic repair.


METHODS
Between January 2001 and June 2008, 76 patients treated with thoracic endovascular aortic repair were prospectively enrolled. The study cohort included 61 men; mean age was 65.4 +/- 16.8 years. All patients underwent a specific neurologic assessment on an hourly basis postoperatively to detect neurologic deficits. Cerebrovascular accidents were diagnosed on the basis of physical examination, tomography scan or magnetic resonance imaging, or autopsy.


RESULTS
Cerebrovascular accidents occurred in 8 (10.5%) patients, including 4 transient ischemic attack and 4 major strokes. Four cases were observed within the first 24-hours. Multivariable analysis revealed that anatomic incompleteness of the Willis circle (odds ratio [OR] 17.19, 95% confidence interval [CI] 2.10 to 140.66), as well as the presence of coronary artery disease (OR 6.86, 95 CI% 1.18 to 40.05), were independently associated with postoperative cerebrovascular accident development. Overall hospital mortality was 9.2%, with no significant difference for patients hit by cerebrovascular accidents (25.0% vs 7.3%, p = 0.102).


CONCLUSIONS
Preexisting coronary artery disease, reflecting a severe diseased aorta and anomalies of Willis circle are independent cerebrovascular accident predictors after thoracic endovascular aortic repair procedures. A careful evaluation of the arch vessels and cerebral vascularization should be mandatory for patients suitable for thoracic endovascular aortic repair.
Mariscalco
Giovanni
G
Department of Surgical Sciences-Cardiac Surgery, Varese University Hospital, University of Insubria, Varese, Italy.
Piffaretti
Gabriele
G
Tozzi
Matteo
M
Bacuzzi
Alessandro
A
Carrafiello
Giampaolo
G
Sala
Andrea
A
Castelli
Patrizio
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D004452:Echocardiography; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult