Editor's Choice - Incidence of Stroke Following Thoracic Endovascular Aortic Repair for Descending Aortic Aneurysm: A Systematic Review of the Literature with Meta-analysis

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• 作者：R.S. von Allmen^a ; ^{regula.vonallmen@kssg.ch} ; B. Gahl^b ; J.T. Powell^c
• 关键词：Stroke ; Cerebrovascular event ; TEVAR ; Endovascular ; Thoracic aortic aneurysms ; Systematic review ; Meta-analysis
• 刊名：European Journal of Vascular and Endovascular Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：53
• 期：2
• 页码：176-184
• 全文大小：1187 K
• 卷排序：53

文摘

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.MethodsA 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 I2 statistic.ResultsOf 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 (I2 = 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.ConclusionStroke incidence is an important morbidity after TEVAR, and probably increases if the LSA is covered during the procedure, particularly in those without revascularisation.