Key result
Among 62 patients undergoing hybrid arch TEVAR, postoperative cerebral infarction occurred in 8.1% (5 patients) and was significantly associated with a history of prior stroke, longer operation time, and higher blood transfusion volume.
Observational (n=62)
No
Cerebral infarction after hybrid arch TEVAR can occur due to shaggy aorta or embolization via the left vertebral artery, highlighting the need for careful hemodynamic and anatomical assessment.
Prior stroke may flag higher cerebral infarction risk in hybrid arch TEVAR; leaves open prospective validation before guiding practice.
ハイリスクを有する弓部大動脈瘤患者に対する頸部動脈バイパス術を併用したHybrid arch TEVAR 62例のうち脳梗塞を合併した5例について検討した．2例は弓部から下行大動脈にかけて高度な粥状変化を認めるいわゆるshaggy aortaを呈し，バイパス術後もしくはTEVAR後に多発性の脳梗塞をきたし長期入院の後に感染を契機に失った．他の3例は右腋窩-左総頸/左腋窩動脈バイパスの後TEVARを行ったが，全例がTEVAR後に視覚障害で発症した．責任血管は椎骨動脈の分枝である後大脳動脈と後下小脳動脈であった．バイパス後の血流動態からは，大動脈内で発生した塞栓子が左鎖骨下動脈から左椎骨動脈を介して脳塞栓症をきたしたと考えられた．
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Fujiyoshi et al. (2013) conducted an observational in Aortic arch aneurysm (n=62). Hybrid arch TEVAR was evaluated on Postoperative cerebral infarction. Among 62 patients undergoing hybrid arch TEVAR, postoperative cerebral infarction occurred in 8.1% (5 patients) and was significantly associated with a history of prior stroke, longer operation time, and higher blood transfusion volume.
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