von Allmen R S, Gahl B, Powell J T
Clinic for Vascular Surgery, Kantonsspital St. Gallen, Rorschacherstrasse, St. Gallen, Switzerland.
Clinic for Cardiovascular Surgery, University Hospital Bern and University of Bern, Switzerland.
Eur J Vasc Endovasc Surg. 2017 Feb;53(2):176-184. doi: 10.1016/j.ejvs.2016.10.025. Epub 2016 Dec 18.
Stroke is an increasingly recognised complication following thoracic endovascular aortic repair (TEVAR). The aim of this study was to systematically synthesise the published data on perioperative stroke incidence during TEVAR for patients with descending thoracic aneurysmal disease and to assess the impact of left subclavian artery (LSA) coverage on stroke incidence.
A systematic review of English and German articles on perioperative (in-hospital or 30 day) stroke incidence following TEVAR for descending aortic aneurysm was performed, including studies with ≥50 cases, using MEDLINE and EMBASE (2005-2015). The pooled prevalence of perioperative stroke with 95% CI was estimated using random effect analysis. Heterogeneity was examined using I statistic.
Of 215 studies identified, 10 were considered suitable for inclusion. The included studies enrolled a total of 2594 persons (61% male) between 1997 and 2014 with a mean weighted age of 71.8 (95% CI 71.1-73.6) years. The pooled prevalence for stroke was 4.1% (95% CI 2.9-5.5) with moderate heterogeneity between studies (I = 49.8%, p = .04). Five studies reported stroke incidences stratified by the management of the LSA, that is uncovered versus covered and revascularised versus covered and not-revascularised. In cases where the LSA remained uncovered, the pooled stroke incidence was 3.2% (95% CI 1.0-6.5). There was, however, an indication that stroke incidence increased following LSA coverage, to 5.3% (95% CI 2.6-8.6) in those with a revascularisation and 8.0% (95% CI 4.1-12.9) in those without revascularisation.
Stroke incidence is an important morbidity after TEVAR, and probably increases if the LSA is covered during the procedure, particularly in those without revascularisation.
中风是胸主动脉腔内修复术（TEVAR）后一种日益被认识到的并发症。本研究的目的是系统地综合已发表的关于降主动脉瘤疾病患者在TEVAR围手术期中风发生率的数据，并评估左锁骨下动脉（LSA）覆盖对中风发生率的影响。
使用MEDLINE和EMBASE（2005 - 2015年）对关于降主动脉瘤TEVAR术后围手术期（住院期间或30天内）中风发生率的英文和德文文章进行系统综述，纳入病例数≥50例的研究。采用随机效应分析估计围手术期中风的合并患病率及95%置信区间。使用I统计量检验异质性。
在识别出的215项研究中，10项被认为适合纳入。纳入研究在1997年至2014年间共纳入2594人（61%为男性），平均加权年龄为71.8岁（95%置信区间71.1 - 73.6岁）。中风的合并患病率为4.1%（95%置信区间2.9 - 5.5%），研究间存在中度异质性（I = 49.8%，p = 0.04）。五项研究报告了根据LSA处理方式分层的中风发生率，即未覆盖与覆盖、再血管化与覆盖且未再血管化。在LSA未被覆盖的情况下，合并中风发生率为3.2%（95%置信区间1.0 - 6.5%）。然而，有迹象表明LSA覆盖后中风发生率增加，再血管化患者中为5.3%（95%置信区间2.6 - 8.6%），未再血管化患者中为8.0%（95%置信区间4.1 - 12.9%）。
中风发生率是TEVAR术后的一种重要并发症，并且如果在手术过程中LSA被覆盖，中风发生率可能会增加，尤其是在未进行再血管化的患者中。
