title: Postoperative Stroke after Debranching with Thoracic Endovascular Aortic Repair.
abstract: OBJECTIVE
  This study aimed to analyze the perioperative stroke rate, stroke lesions, outcome, risk factors, and stroke prevention following debranching with thoracic endovascular aortic repair (TEVAR).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Between February 2011 and February 2015, 74 consecutive patients underwent debranching with TEVAR at our institution. Of these, the TEVAR proximal landing zone was "zone 0" in 23 patients, "zone 1" in 28, and "zone 2" in 23. Left subclavian artery (LSA) occlusion with coil embolization, balloon occlusion, or vascular plugging was performed in 27 patients. Mean follow-up time was 19.2 months (range 2-52 months).
  
  
  RESULTS
  The in-hospital mortality rate was 4.1%. Stroke developed in 7 patients (9.5%), zone 0 in 4 patients, zone 1 in 2, and zone 2 in 1. Six of these patients had stroke lesions arising from the vertebral/basilar artery. Univariate analysis revealed a significant increase in the risk of postoperative stroke in patients with intraluminal atheroma (P = 0.001), those who underwent prior percutaneous transluminal coronary angioplasty or coronary artery bypass graft (P = 0.002), and those with a long operative duration (P = 0.001). Additionally, LSA occlusion significantly decreased the incidence of stroke (P = 0.041). The postsurgical 1- and 2-year cumulative survival rates were 87.3% and 77.0%, respectively, in those without stroke, and 68.6% and 22.9%, respectively, in those with stroke (P = 0.012).
  
  
  CONCLUSIONS
  Stroke after debranching with TEVAR was associated with a high mortality. To prevent stroke, careful patient selection and protection of the vertebral artery are important. Prophylactic LSA occlusion at the time of stent-graft deployment might reduce the risk of perioperative stroke.
authors.affiliation: Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan. Electronic address: akihiro197253@yahoo.co.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoshitake
authors.affiliation: Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hachiya
authors.affiliation: Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kitahara
authors.affiliation: Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kawaguchi
authors.affiliation: Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Seishi
authors.initials: S
authors.lastname: Nakatsuka
authors.affiliation: Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Jinzaki
authors.affiliation: Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D021721:Balloon Occlusion; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D016896:Treatment Outcome