title: Analysis of stroke after TEVAR involving the aortic arch.
abstract: OBJECTIVE
  To analyse the incidence of stroke after thoracic endovascular aortic repair (TEVAR) for aortic arch disease.
  
  
  METHODS
  In the last decade, 393 patients received TEVAR at our Institution; in 143 cases the aortic arch was involved (32 zones '0', 35 zones '1' and 76 zone '2'). The left subclavian artery (LSA) was revascularised selectively in 75 cases; the proximal LSA was ligated or occluded with a plug in 55 cases before endograft (EG) deployment.
  
  
  RESULTS
  Initial clinical success, perioperative mortality, spinal cord ischaemia and stroke in TEVAR patients with or without arch involvement were, respectively, 86.7% vs. 94.4%, 4.2% vs. 2.4%, 2.1% vs. 3.6% and 2.8% vs. 1.2%. The stroke rate was 9.4% (P < 0.02) in 'zone 0', 0% in 'zone 1' and 1.3% in 'zone 2' with scans showing severe atheroma and/or thrombus in all cases. Stroke was observed in patients with 2.6% or without 2.9% LSA revascularisation; however, it was never observed in patients in whom the LSA was occluded before EG deployment and in 4.5% of patients in whom it was patent at the time of EG deployment.
  
  
  CONCLUSIONS
  Stroke after TEVAR is not infrequent especially when the arch is involved. Careful patient selection together with a strategy to reduce embolisation such as occlusion of supra-aortic trunks before EG deployment may play a beneficial role.
authors.affiliation: Department of Vascular Surgery, Università Vita-Salute, Scientific Institute H. San Raffaele, Via Olgettina 60, Milan, Italy. g.melissano@hsr.it
authors.forename: G
authors.initials: G
authors.lastname: Melissano
authors.forename: Y
authors.initials: Y
authors.lastname: Tshomba
authors.forename: L
authors.initials: L
authors.lastname: Bertoglio
authors.forename: E
authors.initials: E
authors.lastname: Rinaldi
authors.forename: R
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000453:epidemiology* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D015984:Causality; D015897:Comorbidity; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000453:epidemiology / Q000209:etiology; D015607:Stents; D020521:Stroke / Q000453:epidemiology*; D016896:Treatment Outcome