{"title":"Association Between Bovine Aortic Arch Anatomy and Stroke After Thoracic Endovascular Aortic Repair.","authors":"Zeng-Rong Luo, Zhi-Sheng Wang, Yi-Xing Chen, Min-Cai, Zhong-Yao Huang, Liang-Wan Chen","doi":"10.1177/15266028251321284","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The link between bovine aortic arch (BAA) and stroke after thoracic endovascular aortic repair (TEVAR) was investigated.</p><p><strong>Methods: </strong>The multicenter retrospective study included consecutive Stanford type B aortic dissection patients undergoing TEVAR from January 2019 to December 2023. A multivariable logistic regression was utilized to assess the correlation between BAA and early stroke, while a multivariable Cox regression was employed to evaluate the association between BAA and overall stroke. Kaplan-Meier curves were used to compare the freedom from overall stroke rates.</p><p><strong>Results: </strong>In total, 138 (14.3%) had a BAA and 825 (85.7%) had a standard aortic arch (SAA). Patients with a BAA showed a greater early stroke incidence (11 [8.0%] vs 25 [3.0%]; p=0.005). An independent association was found between BAA and early stroke (odds ratio, 2.009 [95% confidence interval (CI), 1.491-2.684]; p=0.012). During follow-up, a greater incidence of overall stroke was seen in patients with a BAA (15 [10.9%] vs 42 [5.1%]) (hazard ratio, 2.310 [95% CI, 1.889-2.950]; p=0.006). Moreover, the freedom from the overall stroke rate was notably lower in the BAA group (80.42% vs 88.74%) (log-rank p=0.0068). Furthermore, patients with type A BAA showed significantly lower freedom from overall stroke rates (79.48%) relative to those with type B BAA (82.09%) (log-rank p=0.0431), and the freedom from overall stroke rate for patients with BAA ≥60 years was markedly lower (63.35%) than that in those <60 years (93.51%) (log-rank p=0.004).</p><p><strong>Conclusion: </strong>BAA was correlated with an increased risk of early and overall stroke following TEVAR, particularly among older and type A BAA patients.Clinical ImpactIndividualized stroke prevention protocols and efficient neuroprotective measures should be developed for patients with BAA and adequate anticoagulation should be ensured to reduce the risk of embolism during TEVAR. This population should also ensure proper needle alignment. For instance, minimize the contact between the guide wire and the aortic arch wall. Temporal-occlusion of the carotid dynamic pulse during stent release might prevent solid fragments from entering into the craniocerebral artery. Additionally, thorough CO<sub>2</sub> or saline flushing technique can be utilized for all the stentgrafts. Furthermore, distal cerebral embolic protection devices should be conducted in patients with a BAA during TEVAR.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251321284"},"PeriodicalIF":1.7000,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Endovascular Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/15266028251321284","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: The link between bovine aortic arch (BAA) and stroke after thoracic endovascular aortic repair (TEVAR) was investigated.
Methods: The multicenter retrospective study included consecutive Stanford type B aortic dissection patients undergoing TEVAR from January 2019 to December 2023. A multivariable logistic regression was utilized to assess the correlation between BAA and early stroke, while a multivariable Cox regression was employed to evaluate the association between BAA and overall stroke. Kaplan-Meier curves were used to compare the freedom from overall stroke rates.
Results: In total, 138 (14.3%) had a BAA and 825 (85.7%) had a standard aortic arch (SAA). Patients with a BAA showed a greater early stroke incidence (11 [8.0%] vs 25 [3.0%]; p=0.005). An independent association was found between BAA and early stroke (odds ratio, 2.009 [95% confidence interval (CI), 1.491-2.684]; p=0.012). During follow-up, a greater incidence of overall stroke was seen in patients with a BAA (15 [10.9%] vs 42 [5.1%]) (hazard ratio, 2.310 [95% CI, 1.889-2.950]; p=0.006). Moreover, the freedom from the overall stroke rate was notably lower in the BAA group (80.42% vs 88.74%) (log-rank p=0.0068). Furthermore, patients with type A BAA showed significantly lower freedom from overall stroke rates (79.48%) relative to those with type B BAA (82.09%) (log-rank p=0.0431), and the freedom from overall stroke rate for patients with BAA ≥60 years was markedly lower (63.35%) than that in those <60 years (93.51%) (log-rank p=0.004).
Conclusion: BAA was correlated with an increased risk of early and overall stroke following TEVAR, particularly among older and type A BAA patients.Clinical ImpactIndividualized stroke prevention protocols and efficient neuroprotective measures should be developed for patients with BAA and adequate anticoagulation should be ensured to reduce the risk of embolism during TEVAR. This population should also ensure proper needle alignment. For instance, minimize the contact between the guide wire and the aortic arch wall. Temporal-occlusion of the carotid dynamic pulse during stent release might prevent solid fragments from entering into the craniocerebral artery. Additionally, thorough CO2 or saline flushing technique can be utilized for all the stentgrafts. Furthermore, distal cerebral embolic protection devices should be conducted in patients with a BAA during TEVAR.
期刊介绍:
The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.