title: Editor's Choice - Incidence of Stroke Following Thoracic Endovascular Aortic Repair for Descending Aortic Aneurysm: A Systematic Review of the Literature with Meta-analysis.
abstract: Stroke is an increasingly recognised complication following thoracic endovascular aortic repair (TEVAR). The aim of this study was to systematically synthesise the published data on perioperative stroke incidence during TEVAR for patients with descending thoracic aneurysmal disease and to assess the impact of left subclavian artery (LSA) coverage on stroke incidence.
  
  
  
  A systematic review of English and German articles on perioperative (in-hospital or 30 day) stroke incidence following TEVAR for descending aortic aneurysm was performed, including studies with ≥50 cases, using MEDLINE and EMBASE (2005-2015). The pooled prevalence of perioperative stroke with 95% CI was estimated using random effect analysis. Heterogeneity was examined using I2statistic.
  
  
  
  Of 215 studies identified, 10 were considered suitable for inclusion. The included studies enrolled a total of 2594 persons (61% male) between 1997 and 2014 with a mean weighted age of 71.8 (95% CI 71.1-73.6) years. The pooled prevalence for stroke was 4.1% (95% CI 2.9-5.5) with moderate heterogeneity between studies (I2= 49.8%, p = .04). Five studies reported stroke incidences stratified by the management of the LSA, that is uncovered versus covered and revascularised versus covered and not-revascularised. In cases where the LSA remained uncovered, the pooled stroke incidence was 3.2% (95% CI 1.0-6.5). There was, however, an indication that stroke incidence increased following LSA coverage, to 5.3% (95% CI 2.6-8.6) in those with a revascularisation and 8.0% (95% CI 4.1-12.9) in those without revascularisation.
  
  
  
  Stroke incidence is an important morbidity after TEVAR, and probably increases if the LSA is covered during the procedure, particularly in those without revascularisation.
authors.affiliation: Clinic for Vascular Surgery, Kantonsspital St. Gallen, Rorschacherstrasse, St. Gallen, Switzerland. Electronic address: regula.vonallmen@kssg.ch.
authors.forename: R S
authors.initials: RS
authors.lastname: von Allmen
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Bern and University of Bern, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Gahl
authors.affiliation: Vascular Surgery Research Group, Imperial College London, Charing Cross Campus, London, UK.
authors.forename: J T
authors.initials: JT
authors.lastname: Powell
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D015994:Incidence; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D013348:Subclavian Artery / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
keywords: Cerebrovascular event; Endovascular; Meta-analysis; Stroke; Systematic review; TEVAR; Thoracic aortic aneurysms