Neurological Complications After Urgent TEVAR: Risk Factors and Long-Term Outcomes

OBJECTIVE: To evaluate the incidence, associated factors, and long-term outcomes of neurological complications following urgent thoracic endovascular aortic repair (TEVAR). METHODS: This retrospective single-center study included consecutive patients undergoing urgent TEVAR between 2014 and 2025. Primary outcomes were cerebrovascular events, spinal cord ischemia (SCI) and mortality. Associations with clinical, anatomical and procedural variables were assessed using logistic regression. Survival was estimated using Kaplan-Meier analysis. RESULTS: A total of 140 patients (median age 70 years [IQR 60-76]); 61% male) were included. Acute aortic dissection was the most common indication (53%), followed by ruptured (19%) and symptomatic (18%) thoracic aneurysm. Within 30 days, cerebrovascular event occurred in 14 (10%) patients, and SCI in 13 (9%) patients; five patients (4%) developed both complications. Most cerebrovascular events were ischemic strokes (9%). During follow-up, late stroke and SCI were uncommon (3% and 2%, respectively). On univariable analysis, greater aortic coverage was associated with SCI, cerebrovascular events, and 30-day mortality. Left subclavian artery (LSA) revascularization was associated with a lower incidence of SCI (p = 0.04). Estimated overall survival was 83%, 73%, and 66% at 1, 3, and 5 years, respectively. CONCLUSIONS: Urgent TEVAR is associated with a moderate incidence of early neurological complications and acceptable long-term survival. Greater aortic coverage and LSA management were associated with neurological outcomes in unadjusted analyses. These findings support careful consideration of aortic coverage and collateral perfusion during procedural planning.