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 SS11. Management of the Left Subclavian Artery and Stroke After TEVR: Lessons from 1,000 Cases in the MOTHER Registry

​Benjamin O. Patterson1, Peter J. Holt1, Alan Karthikesalingam1, Ian M. Loftus1, Ron M. Fairman2, Matt M. Thompson1
1St. Georges' Vascular Institute, London, United Kingdom; 2Hospital of the University of Pennsylvania, Philadelphia, PA.

OBJECTIVES: Endovascular repair of thoracic aortic aneurysms and dissections (TEVR) has been associated with peri-operative stroke rates as high as 15% in some series. The objective of this study was to determine the incidence of peri-operative stroke following TEVR and to define subsets of patients at increased risk.

METHODS: The MOTHER registry is an amalgamation of five sponsored trials and a single institutional case series with detailed data on 1,010 TEVR. In this study, the peri-operative stroke rate was investigated. Differences between groups were quantified through logistic regression and by comparison of proportions.

RESULTS: Of the 1,010 cases, 48 (4.8%) of patients had a stroke within 30 days. Of these 4 (8.3%) were fatal, but 14 (30%) made a recovery without deficit. Multiple regression analysis demonstrated that female gender (OR=1.9; 95% CI 1.1-3.4; p=0.042), renal insufficiency (OR=2.1; 95% CI 1.1-4; p=0.036), history of CVA (OR=2.4; 95% CI 1.2-4.8; p=0.000) and covering the left subclavian artery without revascularization (OR 3.6; 95% CI 1.9-6.5; p=0.000) were independently predictive of peri-operative stroke. Mode of admission and type of pathology were not of significant influence.

CONCLUSIONS: Coverage of the left subclavian artery without revascularization would appear to be the single most important predictor of post-TEVAR stroke. Not only is this a strong association, but is potentially modifiable by appropriate revascularization procedures.

AUTHOR DISCLOSURES: R. M. Fairman, Nothing to disclose; P. J. Holt, Nothing to disclose; A. Karthikesalingam, Nothing to disclose; I. M. Loftus, Nothing to disclose; B. O. Patterson, Nothing to disclose; M. M. Thompson, Nothing to disclose.

Posted April 2012

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