Department of Vascular Surgery, Università Vita-Salute, Scientific Institute H. San Raffaele, Via Olgettina 60, Milan, Italy.
Eur J Vasc Endovasc Surg. 2012 Mar;43(3):269-75. doi: 10.1016/j.ejvs.2011.12.009. Epub 2012 Jan 10.
To analyse the incidence of stroke after thoracic endovascular aortic repair (TEVAR) for aortic arch disease.
In the last decade, 393 patients received TEVAR at our Institution; in 143 cases the aortic arch was involved (32 zones '0', 35 zones '1' and 76 zone '2'). The left subclavian artery (LSA) was revascularised selectively in 75 cases; the proximal LSA was ligated or occluded with a plug in 55 cases before endograft (EG) deployment.
Initial clinical success, perioperative mortality, spinal cord ischaemia and stroke in TEVAR patients with or without arch involvement were, respectively, 86.7% vs. 94.4%, 4.2% vs. 2.4%, 2.1% vs. 3.6% and 2.8% vs. 1.2%. The stroke rate was 9.4% (P < 0.02) in 'zone 0', 0% in 'zone 1' and 1.3% in 'zone 2' with scans showing severe atheroma and/or thrombus in all cases. Stroke was observed in patients with 2.6% or without 2.9% LSA revascularisation; however, it was never observed in patients in whom the LSA was occluded before EG deployment and in 4.5% of patients in whom it was patent at the time of EG deployment.
Stroke after TEVAR is not infrequent especially when the arch is involved. Careful patient selection together with a strategy to reduce embolisation such as occlusion of supra-aortic trunks before EG deployment may play a beneficial role.
分析胸主动脉腔内修复术（TEVAR）治疗主动脉弓疾病后中风的发生率。
在过去十年中，我们机构收治了 393 例接受 TEVAR 治疗的患者；其中 143 例主动脉弓受累（32 区“0”，35 区“1”和 76 区“2”）。75 例选择性重建左锁骨下动脉（LSA）；55 例在放置血管内移植物（EG）前用结扎或封堵栓子闭塞近端 LSA。
TEVAR 患者无论是否有弓部受累，初始临床成功率、围手术期死亡率、脊髓缺血和中风发生率分别为 86.7%比 94.4%、4.2%比 2.4%、2.1%比 3.6%和 2.8%比 1.2%。“0”区中风发生率为 9.4%（P<0.02），“1”区无中风，“2”区中风发生率为 1.3%，所有病例均有严重动脉粥样硬化和/或血栓。LSA 血运重建率为 2.6%或无 LSA 血运重建率为 2.9%的患者发生中风，但在 EG 置入前 LSA 闭塞的患者和 EG 置入时 LSA 通畅的 4.5%的患者中从未观察到中风。
TEVAR 后中风并不少见，尤其是当弓部受累时。仔细选择患者并采取策略减少栓塞，如在 EG 置入前闭塞升主动脉分支，可能会发挥有益作用。
