Cerebral embolization, silent cerebral infarction and neurocognitive decline after thoracic endovascular aortic repair. BJS 2018; 105: 366-378.
Published: 12th February 2018
Authors: A. H. Perera, N. Rudarakanchana, L. Monzon, C. D. Bicknell, B. Modarai, O. Kirmi et al.
Silent cerebral infarction is brain injury detected incidentally on imaging; it can be associated with cognitive decline and future stroke. This study investigated cerebral embolization, silent cerebral infarction and neurocognitive decline following thoracic endovascular aortic repair (TEVAR).
Patients undergoing elective or emergency TEVAR at Imperial College Healthcare NHS Trust and Guy's and St Thomas' NHS Foundation Trust between January 2012 and April 2015 were recruited. Aortic atheroma graded from 1 (normal) to 5 (mobile atheroma) was evaluated by preoperative CT. Patients underwent intraoperative transcranial Doppler imaging (TCD), preoperative and postoperative cerebral MRI, and neurocognitive assessment.
Fifty‐two patients underwent TEVAR. Higher rates of TCD‐detected embolization were observed with greater aortic atheroma (median 207 for grade 4–5
This study demonstrates a high rate of cerebral embolization and neurocognitive decline affecting patients following TEVAR. Brain injury after TEVAR is more common than previously recognized, with cerebral infarction in more than 80 per cent of patients.Full text
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