Predictive Factors for Cerebrovascular Accidents After Thoracic Endovascular Aortic Repair

被引:29
作者
Mariscalco, Giovanni
Piffaretti, Gabriele [1 ]
Tozzi, Matteo
Bacuzzi, Alessandro
Carrafiello, Giampaolo
Sala, Andrea
Castelli, Patrizio
机构
[1] Univ Insubria, Varese Univ Hosp, Dept Surg Sci Vasc Surg, I-21100 Varese, Italy
关键词
RISK-FACTORS; PERIOPERATIVE STROKE; ANEURYSM REPAIR; COMPLICATIONS; SURGERY;
D O I
10.1016/j.athoracsur.2009.08.020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:1877 / 1881
页数:5
相关论文
共 26 条
[1]   Transcranial Doppler detection of microemboli during percutaneous transluminal coronary angioplasty [J].
Bladin, CF ;
Bingham, L ;
Grigg, L ;
Yapanis, AG ;
Gerraty, R ;
Davis, SM .
STROKE, 1998, 29 (11) :2367-2370
[2]   Influence of guidewire and catheter type on the frequency of cerebral microembolic signals during left heart catheterization [J].
Braekken, SK ;
Endresen, K ;
Russell, D ;
Brucher, R ;
Kjekshus, J .
AMERICAN JOURNAL OF CARDIOLOGY, 1998, 82 (05) :632-637
[3]   Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) Registry [J].
Buth, Jacob ;
Harris, Peter L. ;
Hobo, Roel ;
van Eps, Randolph ;
Cuypers, Philippe ;
Duijm, Lucien ;
Tielbeek, Xander .
JOURNAL OF VASCULAR SURGERY, 2007, 46 (06) :1103-1111
[4]   Thoracoabdominal aneurysm repair: Results with 337 operations performed over a 15-year interval [J].
Cambria, RP ;
Clouse, WD ;
Davison, JK ;
Dunn, PF ;
Corey, M ;
Dorer, D .
ANNALS OF SURGERY, 2002, 236 (04) :471-479
[5]   Midterm results of endovascular repair of descending thoracic aortic aneurysms with first-generation stent grafts [J].
Demers, P ;
Miller, DC ;
Mitchell, RS ;
Kee, ST ;
Sze, D ;
Razavi, MK ;
Dake, MD .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2004, 127 (03) :664-673
[6]   Aortic Arch Atheroma: Stroke Reduction in Cardiac Surgical Patients [J].
Djaiani, George N. .
SEMINARS IN CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2006, 10 (02) :143-157
[7]   Descending thoracic aortic aneurysm: Surgical approach and treatment using the adjuncts cerebrospinal fluid drainage and distal aortic perfusion [J].
Estrera, AL ;
Rubenstein, FS ;
Miller, CC ;
Huynh, TTT ;
Letsou, GV ;
Safi, HJ .
ANNALS OF THORACIC SURGERY, 2001, 72 (02) :481-485
[8]   Results of endovascular repair of the thoracic aorta with the talent thoracic stent graft:: The Talent Thoracic Retrospective Registry [J].
Fattori, Rossella ;
Nienaber, Christoph A. ;
Rousseau, Herve ;
Beregi, Jean-Paul ;
Heijmen, Robin ;
Grabenwoeger, Martin ;
Piquet, Philippe ;
Lovato, Luigi ;
Dabbech, Chaouki ;
Kische, Stephan ;
Gaxotte, Virginia ;
Schepens, Marc ;
Ehrlich, Marek ;
Bartoli, Jean-Michelle .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2006, 132 (02) :332-339
[9]  
Feezor RJ, 2007, J ENDOVASC THER, V14, P568, DOI 10.1583/1545-1550(2007)14[568:RFFPSD]2.0.CO
[10]  
2