A systematic review and meta-analysis of stroke rates in patients undergoing thoracic endovascular aortic repair for descending thoracic aortic aneurysm and type B dissection

• Published in: Journal of vascular surgery Vol. 76; no. 1; pp. 292 - 301.e3
• Main Authors: Karaolanis, Georgios I., Antonopoulos, Constantine N., Charbonneau, Philippe, Georgakarakos, Efstratios, Moris, Demetrios, Scali, Salvatore, Kotelis, Drosos, Donas, Konstantinos
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2022
• Subjects: Cerebrovascular event; Dissection; Stroke; Thoracic aortic aneurysms; Thoracic endovascular aortic repair; Cerebrovascular event; Thoracic endovascular aortic repair; Stroke; Thoracic aortic aneurysms; Dissection; thoracic endovascular aortic repair; cerebrovascular event; thoracic aortic aneurysms; dissection
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2022.02.031

We performed a systematic review and meta-analysis to assess the stroke rates after thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysms and/or dissections.
A systematic search of all the literature reported until September 2021 was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The pooled perioperative stroke rates and corresponding 95% confidence intervals (CIs) were estimated using fixed or random effect methods.
A total of 878 study titles were identified by the initial search strategy, of which 43 were considered eligible for inclusion in the meta-analysis. A total of 5764 patients (63.5% male) were identified among the eligible studies. The pooled any stroke rate was 4.4% (95% CI, 3.60%-5.28%). However, after procedures without left subclavian artery (LSA) ostial coverage (eg, TEVAR deployed within or distal to zone ≥3), the stroke rate was 3.15% (95% CI, 2.21%-4.22%). For the patients with LSA coverage, the pooled stroke rate was 2.8% (95% CI, 1.69%-4.14%) for patients receiving left subclavian artery revascularization. However, the patients without LSA revascularization had a pooled estimated stroke incidence of 11.8% (95% CI, 5.85%-19.12%).
Stroke has been a common finding after TEVAR, especially with LSA coverage without revascularization, validating current clinical practice guidelines recommending routine revascularization, when feasible. Additional studies with larger patient numbers that provide separate data regarding the aortic pathology treated, the anatomic location of the stroke and their association with functional recovery and survival are needed.