ArticleJTCVS structural and endovascular2025
Treatment of innominate artery during thoracic endovascular aortic repair is associated with higher stroke rate.
Article in JTCVS structural and endovascular, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To evaluate clinical outcomes based on method of branch vessel revascularization for thoracic endovascular aortic repair (TEVAR) with proximal landing zone (pLZ) 0 or 1 reported in the Vascular Quality Initiative (VQI). Methods: The VQI TEVAR Registry was queried for patients with a pLZ documented as 0 or 1 for any pathology during the years 2011-2024. Patients were grouped by method of branch vessel revascularization using a 3-letter code to represent the innominate, the left carotid, and left subclavian respectively. E represents endovascular treatment, O open surgical bypass, and N represents no intervention (eg, NEE represents no innominate treatment and endovascular revascularization of the left carotid and subclavian). Four groups reflecting common treatment strategies of the innominate were compared: NEE, NOO, EEE, and OOO. Results: A total of 32,490 TEVAR procedures were performed between 2011 and 2024 with 813 zone 0 pLZ and 1010 zone 1 pLZ. 54 had endovascular revascularization of all 3 branch vessels (EEE) and 207 had open revascularization of all branch vessels (OOO). Group EEE had statistically higher rates of aneurysmal disease (77.8%) than other groups (NEE 50.0%, NOO 56.7%, and OOO 62.8%). The groups requiring innominate artery intervention had a significantly higher stroke rate (EEE 20.4%, OOO 9.7%, NEE 6.9%, and NOO 3.7%). Group OOO had higher LOS. Conclusions: Patients requiring revascularization of the innominate artery during proximal TEVAR had higher stroke rates than those who did not. Whether this is related to worse underlying disease or more endovascular manipulation of the arch, and thus amenable to risk modifying techniques, needs further investigation.
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