Endovascular repair of ruptured thoracic aortic aneurysms: predictors of procedure-related stroke

Background: Thoracic endovascular aortic repair (TEVAR) is a valuable tool in the treatment of ruptured descending thoracic aortic aneurysm (rDTAA). A major complication of this procedure is stroke. We investigated the incidence and risk factors for stroke after TEVAR for rDTAA. Methods: We retrospectively evaluated the outcomes of all patients who were treated with TEVAR for rDTAA at seven institutions between 2002 and 2009. A total of 92 patients were identified, with a mean age of 69.4 ± 11 years and 67% were men. Multivariable logistic regression analysis was used to investigate risk factors for stroke, including demographics, comorbidities, aneurysm, and procedural details. Results: The 30-day mortality was 17.4% (n = 16), and 7.6% (n = 7) suffered from procedure-related stroke. Four of seven patients with stroke (57.1%) expired within 30 days, compared with 12 (14.1%) of the patients without stroke (OR, 8.11; p = .004). In multivariable regression analysis, increasing age was associated with an increased risk of stroke (OR, 1.38; 95% CI, 1.08-1.76; p = .010), whereas more recent procedures were associated with a reduced risk of stroke (OR, 0.52; 95% CI, 0.28-0.97; p = .039). The aneurysm-related survival at 1 year after TEVAR was 42.9% for patients who suffered from stroke, and 77.6% for those without stroke (p = .006). Conclusions: Endovascular repair of rDTAA is associated with a considerable risk of stroke, and stroke is an important cause of 30-day mortality in this patient group. Particularly older patients are at risk for developing stroke after endovascular repair of rDTAA. The risk of stroke decreased significantly over time in this evaluation.