• G Melissano, Y Tshomba, L Bertoglio, E Rinaldi, and R Chiesa.
• Department of Vascular Surgery, Università Vita-Salute, Scientific Institute H. San Raffaele, Via Olgettina 60, Milan, Italy. g.melissano@hsr.it
• Eur J Vasc Endovasc Surg. 2012 Mar 1;43(3):269-75.

ObjectiveTo analyse the incidence of stroke after thoracic endovascular aortic repair (TEVAR) for aortic arch disease.MethodsIn the last decade, 393 patients received TEVAR at our Institution; in 143 cases the aortic arch was involved (32 zones '0', 35 zones '1' and 76 zone '2'). The left subclavian artery (LSA) was revascularised selectively in 75 cases; the proximal LSA was ligated or occluded with a plug in 55 cases before endograft (EG) deployment.ResultsInitial clinical success, perioperative mortality, spinal cord ischaemia and stroke in TEVAR patients with or without arch involvement were, respectively, 86.7% vs. 94.4%, 4.2% vs. 2.4%, 2.1% vs. 3.6% and 2.8% vs. 1.2%. The stroke rate was 9.4% (P < 0.02) in 'zone 0', 0% in 'zone 1' and 1.3% in 'zone 2' with scans showing severe atheroma and/or thrombus in all cases. Stroke was observed in patients with 2.6% or without 2.9% LSA revascularisation; however, it was never observed in patients in whom the LSA was occluded before EG deployment and in 4.5% of patients in whom it was patent at the time of EG deployment.ConclusionsStroke after TEVAR is not infrequent especially when the arch is involved. Careful patient selection together with a strategy to reduce embolisation such as occlusion of supra-aortic trunks before EG deployment may play a beneficial role.Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

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