Renewed Focus on Stroke as a Complication of Thoracic Aortic Procedures

Thoracic endovascular aortic repair (TEVAR) is powerfully emerging as an excellent and likely superior treatment option for many patients with aneurysms and other aortic pathologies. Lower 30-day mortality and fewer complications constitute the most significant advantages offered by stent-graft intervention when compared with the risks of open surgical repair (OR). 

However, stroke remains a challenge with TEVAR-related rates that appear to be no lower than those associated with OR – if not higher in some instances. It can occur through a variety of mechanisms, and both ischemic and hemorrhagic strokes have been reported. Risk factors are beginning to be clarified, but many aspects are yet to be sorted out.

For some reason, TEVAR-induced stroke remained almost totally off the radar for several years, perhaps overshadowed by the “fear of paraplegia” that has always ranked atop all things related to the thoracic aorta. But this has changed now with the realization that stroke risk is as high as that of paraplegia, and frequently higher. The nice review article on stroke following open and endovascular thoracic aortic repair by Lyons et al appearing in this issue of  VDM is timely and quite instructive in this regard.