Left Subclavian Artery Revascularization and Early Neurological Outcomes After Zone 2 TEVAR

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic disease requiring zone 2 thoracic endovascular aortic repair (TEVAR) with intentional left subclavian artery (LSA) coverage (n=32). Intervention: Preoperative or concomitant left subclavian artery (LSA) revascularization vs. No preoperative or concomitant LSA revascularization. Primary outcome: Any 30-day neurological complication (including ischemic or hemorrhagic stroke, transient ischemic attack, and spinal cord ischemia) (RR 0.70, 95% CI 0.19-2.58, p=0.667).

Q: What does this research mean for the field?

Left subclavian artery revascularization during zone 2 TEVAR is associated with a numerically lower but statistically non-significant difference in 30-day neurological complications compared with intentional coverage without revascularization. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Osman Eren Karpuzoğlu; Anıl Karaağaç; Burak Bozkurt; Recep Çalışkan; Mukan Kağan Kuş; Murat Baştopçu; Canan Karakaya; Cevdet Uğur KOÇOĞULLARI

doi:10.1016/j.avsg.2026.10.052

November 1, 2026Annals of Vascular Surgery

Left Subclavian Artery Revascularization and Early Neurological Outcomes After Zone 2 TEVAR

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Key result

Preoperative or concomitant LSA revascularization during zone 2 TEVAR did not significantly reduce 30-day neurological complications vs no revascularization (19.0% vs 27.3%; RR 0.70; p=0.667).

Why the study?

Does preoperative or concomitant left subclavian artery revascularization reduce early 30-day neurological complications in patients undergoing zone 2 TEVAR with intentional LSA coverage?

Key Points

To assess the association between preoperative or concomitant left subclavian artery (LSA) revascularization and 30-day neurological complications after zone 2 TEVAR.
Single-center retrospective study of 32 patients undergoing zone 2 TEVAR with intentional LSA coverage between January 2018 and December 2024.
Patients were categorized by whether LSA revascularization was performed preoperatively or concomitantly (Rev+, n=21) versus omitted (Rev-, n=11).
Early 30-day neurological complications occurred in 4 of 21 patients (19.0%) in the Rev+ group and 3 of 11 (27.3%) in the Rev- group (RR 0.70, 95% CI 0.19-2.58; OR 0.62, 95% CI 0.12-3.34; p=0.582).
Major neurological events occurred in 3 of 21 patients (14.3%) in the Rev+ group versus 2 of 11 (18.2%) in the Rev- group (p=1.000), with stroke occurring in 14.3% vs 9.1% and spinal cord ischemia in 0% vs 9.1%.

Study Design

Type

Cohort (n=32)

Multicenter

No

Structured PICO

Does preoperative or concomitant left subclavian artery revascularization reduce early 30-day neurological complications in patients undergoing zone 2 TEVAR with intentional LSA coverage?

P

Population

32 patients undergoing zone 2 TEVAR with intentional left subclavian artery coverage at a single center, followed for 30 days.

E

Exposure

Preoperative or concomitant left subclavian artery (LSA) revascularization during zone 2 TEVAR with intentional LSA coverage

C

Comparator

No preoperative or concomitant left subclavian artery (LSA) revascularization during zone 2 TEVAR with intentional LSA coverage

O

Outcome

Any 30-day neurological complication, including ischemic or hemorrhagic stroke, transient ischemic attack (TIA), and spinal cord ischemia (SCI)composite

Main Result

Relative Risk: 0.7 (95% CI 0.19–2.58)

Absolute Event Rate: 19% vs 27.3%

Absolute Risk Reduction: 8.2%

p-value: p=0.667

In this small single-center cohort of zone 2 TEVAR with intentional LSA coverage, preoperative or concomitant LSA revascularization was associated with a numerically lower but statistically non-significant rate of 30-day neurological complications.

Limitations

Single-center retrospective design
Small sample size requiring larger studies to better define the association
Single-center retrospective study
Small sample size (n=32); larger studies are needed to better define the association

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Implication

LSA revascularization decisions in urgent zone 2 TEVAR should remain individualized; single-center retrospective data leaves open effects on early neurological outcomes.

Abstract

BACKGROUND: LSA revascularization is generally favored when intentional LSA coverage is planned during elective zone 2 TEVAR, whereas in urgent settings the decision is individualized according to anatomy, ischemic risk, and clinical urgency. This study evaluated the association between preoperative or concomitant LSA revascularization and early neurological outcomes after zone 2 TEVAR. METHODS: This single-center retrospective study included 32 patients who underwent zone 2 TEVAR with intentional LSA coverage between January 2018 and December 2024. Patients were classified according to whether LSA revascularization was performed before or concomitantly with TEVAR (Rev+, n=21) or not (Rev-, n=11). The primary endpoint was any 30 day neurological complication, including ischemic or hemorrhagic stroke, transient ischemic attack (TIA), and spinal cord ischemia (SCI). Major neurological events, defined as stroke or SCI, were additionally evaluated. RESULTS: Early neurological complications occurred in 4/21 patients (19.0%) in the Rev+ group and 3/11 (27.3%) in the Rev- group (p=.667), corresponding to an absolute risk difference of -8.2 percentage points (95% CI, -39.4 to 23.0) and a risk ratio of 0.70 (95% CI, 0.19-2.58). Major neurological events occurred in 3/21 (14.3%) and 2/11 (18.2%) patients, respectively (p=1.000). Stroke occurred in 3/21 (14.3%) Rev+ patients and 1/11 (9.1%) Rev- patients, while SCI occurred in no Rev+ patients and in 1/11 (9.1%) Rev- patients. LSA revascularization was not significantly associated with the primary endpoint (OR, 0.62; 95% CI, 0.12-3.34; p=.582). Results remained similar after separate adjustment for age, dissection, urgency, coronary artery disease, and chronic kidney disease. Sensitivity analyses using major neurological events as the endpoint and including postoperative LSA revascularization in the exposure definition also yielded similar results. CONCLUSIONS: Preoperative or concomitant LSA revascularization during zone 2 TEVAR was associated with a numerically lower rate of early neurological complications, although the difference was not statistically significant. Larger studies are needed to better define the association between LSA revascularization and neurological outcomes after zone 2 TEVAR.

Discussion

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Cite This Study

Karpuzoğlu et al. (2026) conducted a cohort in Aortic disease requiring zone 2 thoracic endovascular aortic repair (TEVAR) with intentional left subclavian artery (LSA) coverage (n=32). Preoperative or concomitant left subclavian artery (LSA) revascularization vs. No preoperative or concomitant LSA revascularization was evaluated on Any 30-day neurological complication (including ischemic or hemorrhagic stroke, transient ischemic attack, and spinal cord ischemia) (RR 0.70, 95% CI 0.19-2.58, p=0.667). Preoperative or concomitant LSA revascularization during zone 2 TEVAR did not significantly reduce 30-day neurological complications vs no revascularization (19.0% vs 27.3%; RR 0.70; p=0.667).

synapsesocial.com/papers/6aef1b4c30498f842f31bfc9 https://doi.org/10.1016/j.avsg.2026.10.052

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Left Subclavian Artery Revascularization and Early Neurological Outcomes After Zone 2 TEVAR

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Left Subclavian Artery Revascularization and Early Neurological Outcomes After Zone 2 TEVAR

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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