TY - JOUR
T1 - Neurological event rates and associated risk factors in acute type B aortic dissections treated by thoracic aortic endovascular repair
AU - IRAD Investigators
AU - Reutersberg, Benedikt
AU - Gleason, Thomas
AU - Desai, Nimesh
AU - Ehrlich, Marek
AU - Evangelista, Arturo
AU - Braverman, Alan
AU - Myrmel, Truls
AU - Chen, Edward P.
AU - Estrera, Anthony
AU - Schermerhorn, Marc
AU - Bossone, Eduardo
AU - Pai, Chih Wen
AU - Eagle, Kim
AU - Sundt, Thoralf
AU - Patel, Himanshu
AU - Trimarchi, Santi
AU - Eckstein, Hans Henning
N1 - Publisher Copyright:
© 2022 The American Association for Thoracic Surgery
PY - 2024/1
Y1 - 2024/1
N2 - Objectives: Thoracic endovascular aortic repair is the method of choice in patients with complicated type B acute aortic dissection. However, thoracic endovascular aortic repair carries a risk of periprocedural neurological events including stroke and spinal cord ischemia. We aimed to look at procedure-related neurological complications within a large cohort of patients with type B acute aortic dissection treated by thoracic endovascular aortic repair. Methods: Between 1996 and 2021, the International Registry of Acute Aortic Dissection collected data on 3783 patients with type B acute aortic dissection. For this analysis, 648 patients with type B acute aortic dissection treated by thoracic endovascular aortic repair were included (69.4% male, mean age 62.7 ± 13.4 years). Patients were excluded who presented with a preexisting neurologic deficit or received adjunctive procedures. Demographics, clinical symptoms, and outcomes were analyzed. The primary end point was the periprocedural incidence of neurological events (defined as stroke, spinal cord ischemia, transient neurological deficit, or coma). Predictors for perioperative neurological events and follow-up outcomes were considered as secondary end points. Results: Periprocedure neurological events were noted in 72 patients (11.1%) and included strokes (n = 29, 4.6%), spinal cord ischemias (n = 21, 3.3%), transient neurological deficits (n = 16, 2.6%), or coma (n = 6, 1.0%). The group with neurological events had a significantly higher in-hospital mortality (20.8% vs 4.3%, P <.001). Patients with neurological events were more likely to be female (40.3% vs 29.3%, P =.077), and aortic rupture was more often cited as an indication for thoracic endovascular aortic repair (38.8% vs 16.5%, P <.001). In patients with neurological events, more stent grafts were used (2 vs 1 stent graft, P =.002). Multivariable logistic regression analysis showed that aortic rupture (odds ratio, 3.12, 95% confidence interval, 1.44-6.78, P =.004) and female sex (odds ratio, 1.984, 95% confidence interval, 1.031-3.817, P =.040) were significantly associated with perioperative neurological events. Conclusions: In this highly selected group from dedicated aortic centers, more than 1 in 10 patients with type B acute aortic dissection treated by thoracic endovascular aortic repair had neurological events, in particular women. Further research is needed to identify the causes and presentation of these events after thoracic endovascular aortic repair, especially among women.
AB - Objectives: Thoracic endovascular aortic repair is the method of choice in patients with complicated type B acute aortic dissection. However, thoracic endovascular aortic repair carries a risk of periprocedural neurological events including stroke and spinal cord ischemia. We aimed to look at procedure-related neurological complications within a large cohort of patients with type B acute aortic dissection treated by thoracic endovascular aortic repair. Methods: Between 1996 and 2021, the International Registry of Acute Aortic Dissection collected data on 3783 patients with type B acute aortic dissection. For this analysis, 648 patients with type B acute aortic dissection treated by thoracic endovascular aortic repair were included (69.4% male, mean age 62.7 ± 13.4 years). Patients were excluded who presented with a preexisting neurologic deficit or received adjunctive procedures. Demographics, clinical symptoms, and outcomes were analyzed. The primary end point was the periprocedural incidence of neurological events (defined as stroke, spinal cord ischemia, transient neurological deficit, or coma). Predictors for perioperative neurological events and follow-up outcomes were considered as secondary end points. Results: Periprocedure neurological events were noted in 72 patients (11.1%) and included strokes (n = 29, 4.6%), spinal cord ischemias (n = 21, 3.3%), transient neurological deficits (n = 16, 2.6%), or coma (n = 6, 1.0%). The group with neurological events had a significantly higher in-hospital mortality (20.8% vs 4.3%, P <.001). Patients with neurological events were more likely to be female (40.3% vs 29.3%, P =.077), and aortic rupture was more often cited as an indication for thoracic endovascular aortic repair (38.8% vs 16.5%, P <.001). In patients with neurological events, more stent grafts were used (2 vs 1 stent graft, P =.002). Multivariable logistic regression analysis showed that aortic rupture (odds ratio, 3.12, 95% confidence interval, 1.44-6.78, P =.004) and female sex (odds ratio, 1.984, 95% confidence interval, 1.031-3.817, P =.040) were significantly associated with perioperative neurological events. Conclusions: In this highly selected group from dedicated aortic centers, more than 1 in 10 patients with type B acute aortic dissection treated by thoracic endovascular aortic repair had neurological events, in particular women. Further research is needed to identify the causes and presentation of these events after thoracic endovascular aortic repair, especially among women.
KW - TEVAR
KW - neurological event
KW - spinal cord ischemia
KW - stroke
KW - transient ischemic attack
KW - type B aortic dissection
UR - http://www.scopus.com/inward/record.url?scp=85125696296&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2022.02.007
DO - 10.1016/j.jtcvs.2022.02.007
M3 - Article
C2 - 35260280
AN - SCOPUS:85125696296
SN - 0022-5223
VL - 167
SP - 52-62.e5
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 1
ER -