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Original Articles: Adult Cardiac

Predictive Factors for Cerebrovascular Accidents After Thoracic Endovascular Aortic Repair

^a Department of Surgical Sciences—Cardiac Surgery, Varese University Hospital, University of Insubria, Varese, Italy
^b Department of Surgical Sciences—Vascular Surgery, Varese University Hospital, University of Insubria, Varese, Italy
^c Department of Surgical Sciences, Anaesthesia and Palliative Care, Varese University Hospital, University of Insubria, Varese, Italy
^d Department of Radiology—Interventional Radiology, Varese University Hospital, University of Insubria, Varese, Italy

Accepted for publication August 11, 2009.

^_* Address correspondence to Dr Piffaretti, Department of Surgical Sciences-Vascular Surgery, Varese University Hospital, University of Insubria, Viale Guicciardini 9, Varese, 21100, Italy (Email: gabriele.piffaretti{at}uninsubria.it).

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.

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