Association of Subclavian Artery Blood Flow with Stroke After Thoracic Endovascular Aortic Repair with Single-Branch Stent Graft

Abstract

Purpose:

To investigate the stroke risk factors following thoracic endovascular aortic repair (TEVAR) with a single-branch stent graft.

Materials and Methods:

We retrospectively analyzed 128 patients of acute aortic syndromes with inadequate proximal landing zones (PLZ) who underwent TEVAR from September 2019 to December 2023. Patient survival was evaluated using the Kaplan–Meier method, and the relationship between subclavian artery patency and stroke incidence was determined through Cox regression analysis.

Results:

Technical success rates for aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) were 98.3%, 100%, and 100%, respectively. There were no significant differences in surgery duration, hospital stay, stent length, and oversize across the groups. Over an 18-month follow-up, there were no significant differences in mortality, stroke incidence, or re-intervention rates among the groups. The rates of stroke post-treatment were 4.9% for AD, 11.8% for IMH, and 12.0% for PAU. Notably, subclavian artery stenosis increased the stroke risk by 37.94 times (hazard ratio, 37.94; 95% CI: 4.76–302.35; p < 0.001). Female patients had a 16.57-fold increased risk of stroke (hazard ratio: 16.57; 95% CI: 1.00–272.88; p = 0.049). In addition, each standard deviation increase in operation time raised the stroke rate by 1.03 times (hazard ratio: 1.03; 95% CI: 1.001–1.05; p = 0.003). Subclavian artery stenosis also significantly increased the risk of re-intervention by 44.14 times (hazard ratio: 44.14; 95% CI: 7.50–259.73; p < 0.001), with significant differences in re-intervention rates among the 3 groups, notably improved in the PAU group compared to the AD group (hazard ratio: 3.60; 95% CI: 1.01–12.82; p = 0.042).

Conclusion:

This study underscores the critical importance of maintaining subclavian artery branch patency post-TEVAR to mitigate stroke and re-intervention risks.

Clinical Impact

This study comprehensively investigates the risk of stroke following the reconstruction of subclavian artery branches during thoracic endovascular aortic repair (TEVAR). While previous literature has extensively documented stroke rates associated with the coverage of subclavian artery branches post-TEVAR, reports on stroke following single-branch stent placement are relatively scarce. By analyzing data from patients with inadequate proximal landing zones who received a single-branch stent, this study identifies potential risk factors for stroke and provides a new perspective on postoperative complications specifically related to subclavian artery reconstruction. Our findings significantly contribute to the literature by offering a novel approach to understanding complications after TEVAR, enhancing the precision of risk analysis for postoperative complications.