Publication
Incidence of Stroke Following Thoracic Endovascular Aortic Repair for Descending Aortic Aneurysm: A Systematic Review of the Literature with Meta-analysis
Journal Paper/Review - Feb 16, 2017
von Allmen Regula, Gahl B, Powell J T
Units
Keywords
Aortic Aneurysm, Thoracic/diagnosis/mortality/physiopathology/*surgery
Blood Vessel Prosthesis Implantation/*adverse effects/mortality
Endovascular Procedures/*adverse effects/mortality
Female
Humans
Incidence
Male
Prevalence
Risk Assessment
Risk Factors
Stroke/diagnosis/*epidemiology/mortality
Subclavian Artery/physiopathology/*surgery
Treatment Outcome
*Cerebrovascular event
*Endovascular
*Meta-analysis
*Stroke
*Systematic review
*Tevar
*Thoracic aortic aneurysms
PubMed
Doi
Contact
Citation
Type
Journal
Publication Date
Issn Electronic
Pages
Brief description/objective
OBJECTIVE
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.
METHODS
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(2) statistic.
RESULTS
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(2) = 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.
CONCLUSION
Stroke incidence is an important morbidity after TEVAR, and probably increases if the LSA is covered during the procedure, particularly in those without revascularisation.