Transcranial Doppler findings during thoracic endovascular aortic repair

• Published in: Journal of vascular surgery 2011-08, Vol.54 (2), p.364-369
• Main Authors: Bismuth, Jean, MD, Garami, Zsolt, MD, Anaya-Ayala, Javier E., MD, Naoum, Joseph J., MD, El Sayed, Hosam F., MD, Peden, Eric K., MD, Lumsden, Alan B., MD, Davies, Mark G., MD, PhD, MBA
• Format: Article
• Language: English
• Subjects: Aged; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - physiopathology; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Flow Velocity; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Cardiology. Vascular system; Cerebrovascular Circulation; Diseases of the aorta; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - mortality; Female; Humans; Intracranial Embolism - diagnostic imaging; Intracranial Embolism - etiology; Intracranial Embolism - mortality; Intracranial Embolism - physiopathology; Ischemic Attack, Transient - etiology; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative - methods; Predictive Value of Tests; Prospective Studies; Prosthesis Design; Pulsatile Flow; Risk Assessment; Risk Factors; Stents; Stroke - etiology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Texas; Treatment Outcome; Ultrasonography, Doppler, Transcranial; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2010.12.063

Objective Thoracic endograft placement has become an acceptable treatment alternative to open repair of the thoracic aorta. Cerebral embolization when manipulating the aortic arch during cardiac catheterization is well described, but the influence of thoracic endovascular aortic repair (TEVAR) on this event remains poorly studied. Our aim was to quantify the number of microembolic signals (MES) detected by transcranial Doppler (TCD) during different stages of TEVAR and correlate them with landing zones, subclavian revascularization, and postoperative morbidity and mortality. Methods TCD was used to monitor 20 patients during TEVAR for the treatment of thoracic aortic aneurysms (TAAs) in 17 (85%) patients, followed by three (15%) with chronic type B aortic dissection and one (5%) Crawford type I thoracoabdominal aortic aneurysm (TAAA). Imaging and medical parameters were entered into a combined database. TCD signals were recorded digitally for the entire case. MES, velocities, and pulsatility index values were entered into a combined database. Results The total number of MES calculated for the diagnostic phase before TEVAR placement and during the treatment phase for all cases combined was 1081 and 1141, respectively. The highest MES counts were generated by the pigtail catheter placement during the diagnostic phase and by device placement during the treatment phase. Embolic count to right/left sides was equal overall. In the diagnostic phase, an average of nine MES were seen right/left, whereas during the treatment phase, 45 and 43 MES were seen, respectively, for right/left. A significant association was found between the total number of MES and postoperative stroke, transient ischemic attack ( P = .0055), and death ( P = .0053). Conclusions TCD can detect microemboli during TEVAR and is able to identify the procedural aspects most associated with cerebral microemboli.