Jonker Frederik H W, Verhagen Hence J M, Heijmen Robin H, Lin Peter H, Trimarchi Santi, Lee W Anthony, Moll Frans L, Athamneh Husam, Muhs Bart E
Yale University School of Medicine, New Haven, CT 06510, USA.
Ann Vasc Surg. 2011 Jan;25(1):3-8. doi: 10.1016/j.avsg.2010.05.001. Epub 2010 Oct 6.
Thoracic endovascular aortic repair (TEVAR) is a valuable tool in the treatment of ruptured descending thoracic aortic aneurysm (rDTAA). A major complication of this procedure is stroke. We investigated the incidence and risk factors for stroke after TEVAR for rDTAA.
We retrospectively evaluated the outcomes of all patients who were treated with TEVAR for rDTAA at seven institutions between 2002 and 2009. A total of 92 patients were identified, with a mean age of 69.4 ± 11 years and 67% were men. Multivariable logistic regression analysis was used to investigate risk factors for stroke, including demographics, comorbidities, aneurysm, and procedural details.
The 30-day mortality was 17.4% (n = 16), and 7.6% (n = 7) suffered from procedure-related stroke. Four of seven patients with stroke (57.1%) expired within 30 days, compared with 12 (14.1%) of the patients without stroke (OR, 8.11; p = .004). In multivariable regression analysis, increasing age was associated with an increased risk of stroke (OR, 1.38; 95% CI, 1.08-1.76; p = .010), whereas more recent procedures were associated with a reduced risk of stroke (OR, 0.52; 95% CI, 0.28-0.97; p = .039). The aneurysm-related survival at 1 year after TEVAR was 42.9% for patients who suffered from stroke, and 77.6% for those without stroke (p = .006).
Endovascular repair of rDTAA is associated with a considerable risk of stroke, and stroke is an important cause of 30-day mortality in this patient group. Particularly older patients are at risk for developing stroke after endovascular repair of rDTAA. The risk of stroke decreased significantly over time in this evaluation.
胸主动脉腔内修复术（TEVAR）是治疗破裂性降主动脉瘤（rDTAA）的一项重要手段。该手术的一个主要并发症是中风。我们调查了rDTAA患者接受TEVAR治疗后中风的发生率及危险因素。
我们回顾性评估了2002年至2009年间在七家机构接受TEVAR治疗的rDTAA患者的治疗结果。共纳入92例患者，平均年龄69.4±11岁，67%为男性。采用多变量逻辑回归分析来研究中风的危险因素，包括人口统计学特征、合并症、动脉瘤情况及手术细节。
30天死亡率为17.4%（n = 16），7.6%（n = 7）的患者发生了与手术相关的中风。7例中风患者中有4例（57.1%）在30天内死亡，而未发生中风的患者中有12例（14.1%）死亡（比值比，8.11；p = 0.004）。在多变量回归分析中，年龄增加与中风风险增加相关（比值比，1.38；95%置信区间，1.08 - 1.76；p = 0.010），而较近期的手术与中风风险降低相关（比值比，0.52；95%置信区间，0.28 - 0.97；p = 0.039）。TEVAR术后1年，中风患者的动脉瘤相关生存率为42.9%，未中风患者为77.6%（p = 0.006）。
rDTAA的血管腔内修复术与相当高的中风风险相关，中风是该患者群体30天死亡率的重要原因。特别是老年患者在rDTAA血管腔内修复术后有发生中风的风险。在本评估中，中风风险随时间显著降低。
