Incidence of neurological complications following overstenting of the left subclavian artery

Ernst Weigang, Maximilian Luehr, Andreas Harloff, Wulf Euringer, Christian D. Etz, G. Szabó, Friedhelm Beyersdorf, Michael P. Siegenthaler

Research output: Article

48 Citations (Scopus)

Abstract

Objective: Aortic endovascular stent-graft implantation is associated with low morbidity and mortality rates. Overstenting of the left subclavian artery may be necessary to create a satisfactory proximal 'landing zone' for the stent-graft. Few cases have been published reporting adverse neurological events after overstenting of the left subclavian artery. We thus evaluated whether this procedure is associated with a higher rate of neurological complications by focusing on the management of the supra-aortic vessels. Methods: Twenty patients suffering from aortic arch aneurysms (n = 3), descending aortic aneurysms (n = 7), acute (n = 6) and chronic (n = 4) type-B aortic dissections underwent stent-graft repair with complete (n = 14) or partial (n = 6) overstenting of the left subclavian artery. Three patients underwent overstenting of the entire aortic arch with ascending aortic-bi-carotid bypass grafting. One patient with right carotid and vertebral artery occlusion underwent initial carotid-to-subclavian bypass. All patients subsequently underwent neurological examination and Doppler ultrasound for detection of neurological and peripheral vascular complications. Results: Aortic stent-graft repair was successful in all patients without acute neurologic complications. Two patients developed late central adverse neurological events: right-sided vertebral artery occlusion with brainstem infarction (n = 1) and impaired binocular vision combined with dizziness (n = 1), necessitating secondary subclavian transposition in one patient. Peripheral symptoms related to occlusion of the left subclavian artery were observed in five patients as sensory and motoric deficits of the left hand and arm. Conclusions: Overstenting of the left subclavian artery as treatment of aortic pathologies in high-risk patients is feasible but associated with the risk of neurological complications and peripheral symptoms. Side effects were mild or transient in most of our patients. Detailed preoperative exploration of vascular anatomy and pathology via Doppler ultrasound, CT- or MRI scan is mandatory to avoid adverse neurological events. Prior surgical revascularization of the left subclavian artery is essential in patients with high-grade stenoses, occlusions, or anatomic variants of the supra-aortic branches. Delayed surgical revascularization is necessary only in patients with relevant subclavian steal syndrome or severe peripheral vascular symptoms.

Original languageEnglish
Pages (from-to)628-636
Number of pages9
JournalEuropean Journal of Cardio-thoracic Surgery
Volume31
Issue number4
DOIs
Publication statusPublished - ápr. 2007

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Subclavian Artery
Incidence
Stents
Transplants
Blood Vessels
Doppler Ultrasonography
Vertebral Artery
Aortic Aneurysm
Thoracic Aorta
Brain Stem Infarctions
Subclavian Steal Syndrome
Pathology
Binocular Vision
Neurologic Examination
Dizziness
Patient Rights
Carotid Arteries
Nervous System
Dissection
Anatomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Incidence of neurological complications following overstenting of the left subclavian artery. / Weigang, Ernst; Luehr, Maximilian; Harloff, Andreas; Euringer, Wulf; Etz, Christian D.; Szabó, G.; Beyersdorf, Friedhelm; Siegenthaler, Michael P.

In: European Journal of Cardio-thoracic Surgery, Vol. 31, No. 4, 04.2007, p. 628-636.

Research output: Article

Weigang, E, Luehr, M, Harloff, A, Euringer, W, Etz, CD, Szabó, G, Beyersdorf, F & Siegenthaler, MP 2007, 'Incidence of neurological complications following overstenting of the left subclavian artery', European Journal of Cardio-thoracic Surgery, vol. 31, no. 4, pp. 628-636. https://doi.org/10.1016/j.ejcts.2006.12.026
Weigang, Ernst ; Luehr, Maximilian ; Harloff, Andreas ; Euringer, Wulf ; Etz, Christian D. ; Szabó, G. ; Beyersdorf, Friedhelm ; Siegenthaler, Michael P. / Incidence of neurological complications following overstenting of the left subclavian artery. In: European Journal of Cardio-thoracic Surgery. 2007 ; Vol. 31, No. 4. pp. 628-636.
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abstract = "Objective: Aortic endovascular stent-graft implantation is associated with low morbidity and mortality rates. Overstenting of the left subclavian artery may be necessary to create a satisfactory proximal 'landing zone' for the stent-graft. Few cases have been published reporting adverse neurological events after overstenting of the left subclavian artery. We thus evaluated whether this procedure is associated with a higher rate of neurological complications by focusing on the management of the supra-aortic vessels. Methods: Twenty patients suffering from aortic arch aneurysms (n = 3), descending aortic aneurysms (n = 7), acute (n = 6) and chronic (n = 4) type-B aortic dissections underwent stent-graft repair with complete (n = 14) or partial (n = 6) overstenting of the left subclavian artery. Three patients underwent overstenting of the entire aortic arch with ascending aortic-bi-carotid bypass grafting. One patient with right carotid and vertebral artery occlusion underwent initial carotid-to-subclavian bypass. All patients subsequently underwent neurological examination and Doppler ultrasound for detection of neurological and peripheral vascular complications. Results: Aortic stent-graft repair was successful in all patients without acute neurologic complications. Two patients developed late central adverse neurological events: right-sided vertebral artery occlusion with brainstem infarction (n = 1) and impaired binocular vision combined with dizziness (n = 1), necessitating secondary subclavian transposition in one patient. Peripheral symptoms related to occlusion of the left subclavian artery were observed in five patients as sensory and motoric deficits of the left hand and arm. Conclusions: Overstenting of the left subclavian artery as treatment of aortic pathologies in high-risk patients is feasible but associated with the risk of neurological complications and peripheral symptoms. Side effects were mild or transient in most of our patients. Detailed preoperative exploration of vascular anatomy and pathology via Doppler ultrasound, CT- or MRI scan is mandatory to avoid adverse neurological events. Prior surgical revascularization of the left subclavian artery is essential in patients with high-grade stenoses, occlusions, or anatomic variants of the supra-aortic branches. Delayed surgical revascularization is necessary only in patients with relevant subclavian steal syndrome or severe peripheral vascular symptoms.",
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T1 - Incidence of neurological complications following overstenting of the left subclavian artery

AU - Weigang, Ernst

AU - Luehr, Maximilian

AU - Harloff, Andreas

AU - Euringer, Wulf

AU - Etz, Christian D.

AU - Szabó, G.

AU - Beyersdorf, Friedhelm

AU - Siegenthaler, Michael P.

PY - 2007/4

Y1 - 2007/4

N2 - Objective: Aortic endovascular stent-graft implantation is associated with low morbidity and mortality rates. Overstenting of the left subclavian artery may be necessary to create a satisfactory proximal 'landing zone' for the stent-graft. Few cases have been published reporting adverse neurological events after overstenting of the left subclavian artery. We thus evaluated whether this procedure is associated with a higher rate of neurological complications by focusing on the management of the supra-aortic vessels. Methods: Twenty patients suffering from aortic arch aneurysms (n = 3), descending aortic aneurysms (n = 7), acute (n = 6) and chronic (n = 4) type-B aortic dissections underwent stent-graft repair with complete (n = 14) or partial (n = 6) overstenting of the left subclavian artery. Three patients underwent overstenting of the entire aortic arch with ascending aortic-bi-carotid bypass grafting. One patient with right carotid and vertebral artery occlusion underwent initial carotid-to-subclavian bypass. All patients subsequently underwent neurological examination and Doppler ultrasound for detection of neurological and peripheral vascular complications. Results: Aortic stent-graft repair was successful in all patients without acute neurologic complications. Two patients developed late central adverse neurological events: right-sided vertebral artery occlusion with brainstem infarction (n = 1) and impaired binocular vision combined with dizziness (n = 1), necessitating secondary subclavian transposition in one patient. Peripheral symptoms related to occlusion of the left subclavian artery were observed in five patients as sensory and motoric deficits of the left hand and arm. Conclusions: Overstenting of the left subclavian artery as treatment of aortic pathologies in high-risk patients is feasible but associated with the risk of neurological complications and peripheral symptoms. Side effects were mild or transient in most of our patients. Detailed preoperative exploration of vascular anatomy and pathology via Doppler ultrasound, CT- or MRI scan is mandatory to avoid adverse neurological events. Prior surgical revascularization of the left subclavian artery is essential in patients with high-grade stenoses, occlusions, or anatomic variants of the supra-aortic branches. Delayed surgical revascularization is necessary only in patients with relevant subclavian steal syndrome or severe peripheral vascular symptoms.

AB - Objective: Aortic endovascular stent-graft implantation is associated with low morbidity and mortality rates. Overstenting of the left subclavian artery may be necessary to create a satisfactory proximal 'landing zone' for the stent-graft. Few cases have been published reporting adverse neurological events after overstenting of the left subclavian artery. We thus evaluated whether this procedure is associated with a higher rate of neurological complications by focusing on the management of the supra-aortic vessels. Methods: Twenty patients suffering from aortic arch aneurysms (n = 3), descending aortic aneurysms (n = 7), acute (n = 6) and chronic (n = 4) type-B aortic dissections underwent stent-graft repair with complete (n = 14) or partial (n = 6) overstenting of the left subclavian artery. Three patients underwent overstenting of the entire aortic arch with ascending aortic-bi-carotid bypass grafting. One patient with right carotid and vertebral artery occlusion underwent initial carotid-to-subclavian bypass. All patients subsequently underwent neurological examination and Doppler ultrasound for detection of neurological and peripheral vascular complications. Results: Aortic stent-graft repair was successful in all patients without acute neurologic complications. Two patients developed late central adverse neurological events: right-sided vertebral artery occlusion with brainstem infarction (n = 1) and impaired binocular vision combined with dizziness (n = 1), necessitating secondary subclavian transposition in one patient. Peripheral symptoms related to occlusion of the left subclavian artery were observed in five patients as sensory and motoric deficits of the left hand and arm. Conclusions: Overstenting of the left subclavian artery as treatment of aortic pathologies in high-risk patients is feasible but associated with the risk of neurological complications and peripheral symptoms. Side effects were mild or transient in most of our patients. Detailed preoperative exploration of vascular anatomy and pathology via Doppler ultrasound, CT- or MRI scan is mandatory to avoid adverse neurological events. Prior surgical revascularization of the left subclavian artery is essential in patients with high-grade stenoses, occlusions, or anatomic variants of the supra-aortic branches. Delayed surgical revascularization is necessary only in patients with relevant subclavian steal syndrome or severe peripheral vascular symptoms.

KW - Aortic aneurysm

KW - Aortic dissection

KW - Endovascular stent-graft

KW - Neurological complication

KW - Subclavian artery overstenting

KW - Supra-aortic vessels

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