• Kenta Masada, Toru Kuratani, Kazuo Shimamura, Keiwa Kin, Takayuki Shijo, Takasumi Goto, and Yoshiki Sawa.
• Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
• Eur J Cardiothorac Surg. 2019 Jun 1; 55 (6): 1071-1078.

ObjectivesSilent cerebral infarction is the most common brain injury incidentally detected on imaging and can be associated with increased risks of future stroke and cognitive decline. However, the incidence and risk factors of silent cerebral infarction after thoracic endovascular aortic repair (TEVAR) for aortic arch pathologies remain unclear. This study aimed to examine silent cerebral infarction following TEVAR using diffusion-weighted (DW) magnetic resonance imaging (MRI).MethodsNineteen patients (16 men, mean age 73.3 years) who underwent elective debranching TEVAR (zone 0/1/2 = 3/8/8) were included. Perioperative brain injury was assessed via cerebral DW-MRI before and after the procedure. The atheroma ratio was calculated from preoperative computed tomography images, and we examined the association between the atheroma ratio and development of new postoperative DW-MRI lesions.ResultsTechnical success was achieved in all patients, and no patient died within 30 days postoperatively. Postoperative DW-MRI detected a total of 24 new lesions in 5 (26%) patients (1-9 lesions per patient): 4 (21%) patients with silent cerebral infarction and 1 (5%) patient with clinical stroke. The atheroma ratio of the aortic arch (23.8 ± 2.7% vs 18.3 ± 3.9%; P = 0.023), especially at the proximal landing zone (19.5 ± 2.8% vs 14.7 ± 2.7%; P = 0.014), was significantly higher in patients with new postoperative DW-MRI lesions than that in patients without.ConclusionsThe incidence of silent cerebral infarction following TEVAR with supra-aortic debranching for aortic arch pathologies was 21%, and the severity of atheromatous change in the aortic arch, especially in the proximal landing zone, was positively associated with the development of silent cerebral infarction.© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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