Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results from the STEP Registry
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Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results from the STEP Registry. / Charbonneau, Philippe; Kölbel, Tilo; Rohlffs, Fiona; Eilenberg, Wolf; Planche, Olivier; Bechstein, Matthias; Ristl, Robin; Greenhalgh, Roger; Haulon, Stephan; STEP collaborators.
In: EUR J VASC ENDOVASC, Vol. 61, No. 2, 02.2021, p. 239-245.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results from the STEP Registry
AU - Charbonneau, Philippe
AU - Kölbel, Tilo
AU - Rohlffs, Fiona
AU - Eilenberg, Wolf
AU - Planche, Olivier
AU - Bechstein, Matthias
AU - Ristl, Robin
AU - Greenhalgh, Roger
AU - Haulon, Stephan
AU - STEP collaborators
N1 - Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - OBJECTIVE: Few data exist concerning the rate of silent cerebral ischaemic events following endovascular treatment of the aortic arch. The objective of this work was to quantify these lesions using the STEP registry (NCT04489277).METHODS: This multicentre retrospective cohort study included consecutive patients treated with an aortic endoprosthesis deployed in Ishimaru zone 0-3 and brain diffusion weighted magnetic resonance imaging (DW-MRI) within seven days following the procedure. DW-MRI was performed to identify the location and number of new silent brain infarctions (SBI). All endografts were carbon dioxide flushed prior to implantation.RESULTS: The study population included 91 patients (mean age, 69 years; men, 64%) from two academic centres treated between September 2018 and January 2020. The procedure was elective in 71 patients (78%). The treatment was performed for a dissection, degenerative aneurysm, or other aortic disease in 44 (49%), 34 (37%), and 13 (14%) patients, respectively. Endografts were deployed in zone 0, 1, 2 or 3 in 23 (25%), 10 (11%), 47 (52%), and 11 (12%) patients, respectively. Endografts were branched (25%), fenestrated (17%), or tubular (58%). At 30 days, there were no deaths or clinical strokes. On cerebral DW-MRI, a total of 245 SBI were identified in 45 patients (50%). Lesions were in the left hemisphere in 63% of the patients (153/245), predominantly in the middle territory (94/245). Deployment in zone 0-1 (p = .026), placement of a branched or fenestrated endograft (p = .038), a proximal endoprosthesis diameter ≥ 40 mm (p = .038), and an urgent procedure (p = .005) were significantly associated with the presence of SBI on univariable analysis, while urgent procedure was found to be an independent predictor on multivariable analysis (binary logistic regression) (p = .002).CONCLUSION: SBI following endovascular repair of the aortic arch is frequent, although there were no clinical strokes. Innovative strategies to reduce the risk of embolisation need to be developed.
AB - OBJECTIVE: Few data exist concerning the rate of silent cerebral ischaemic events following endovascular treatment of the aortic arch. The objective of this work was to quantify these lesions using the STEP registry (NCT04489277).METHODS: This multicentre retrospective cohort study included consecutive patients treated with an aortic endoprosthesis deployed in Ishimaru zone 0-3 and brain diffusion weighted magnetic resonance imaging (DW-MRI) within seven days following the procedure. DW-MRI was performed to identify the location and number of new silent brain infarctions (SBI). All endografts were carbon dioxide flushed prior to implantation.RESULTS: The study population included 91 patients (mean age, 69 years; men, 64%) from two academic centres treated between September 2018 and January 2020. The procedure was elective in 71 patients (78%). The treatment was performed for a dissection, degenerative aneurysm, or other aortic disease in 44 (49%), 34 (37%), and 13 (14%) patients, respectively. Endografts were deployed in zone 0, 1, 2 or 3 in 23 (25%), 10 (11%), 47 (52%), and 11 (12%) patients, respectively. Endografts were branched (25%), fenestrated (17%), or tubular (58%). At 30 days, there were no deaths or clinical strokes. On cerebral DW-MRI, a total of 245 SBI were identified in 45 patients (50%). Lesions were in the left hemisphere in 63% of the patients (153/245), predominantly in the middle territory (94/245). Deployment in zone 0-1 (p = .026), placement of a branched or fenestrated endograft (p = .038), a proximal endoprosthesis diameter ≥ 40 mm (p = .038), and an urgent procedure (p = .005) were significantly associated with the presence of SBI on univariable analysis, while urgent procedure was found to be an independent predictor on multivariable analysis (binary logistic regression) (p = .002).CONCLUSION: SBI following endovascular repair of the aortic arch is frequent, although there were no clinical strokes. Innovative strategies to reduce the risk of embolisation need to be developed.
KW - Adult
KW - Aged
KW - Aorta, Thoracic/surgery
KW - Aortic Diseases/surgery
KW - Asymptomatic Diseases
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Brain Infarction/diagnostic imaging
KW - Diffusion Magnetic Resonance Imaging
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Humans
KW - Incidence
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Postoperative Complications/diagnostic imaging
KW - Registries
KW - Retrospective Studies
U2 - 10.1016/j.ejvs.2020.11.021
DO - 10.1016/j.ejvs.2020.11.021
M3 - SCORING: Journal article
C2 - 33358103
VL - 61
SP - 239
EP - 245
JO - EUR J VASC ENDOVASC
JF - EUR J VASC ENDOVASC
SN - 1078-5884
IS - 2
ER -
