Selective coverage of the left subclavian artery without revascularization in patients with bilateral patent vertebrobasilar junctions during thoracic endovascular aortic repair

Abstract

OBJECTIVE: The primary purpose of the current study was to evaluate the safety and effectiveness of selective coverage of the left subclavian artery (LSCA) without revascularization during thoracic endovascular aortic repair (TEVAR) in patients with bilateral patent vertebrobasilar junctions. The secondary purpose was to assess morphologic change of the vertebral artery (VA) after the procedure. METHODS: Among 126 patients who underwent TEVAR between 2006 and 2011, 29 patients requiring LSCA coverage without preemptive revascularization were retrospectively analyzed in this study. The patients were a mean age of 63.1 years (range, 45-84 years). The mean follow-up period was 19.9 months (range, 1-63 months). Bilateral patent vertebrobasilar junctions were evaluated by contrast-enhanced computed tomography (CT), time-of flight magnetic resonance angiography, or conventional angiography. Neurologic complications, such as spinal cord ischemia (SCI) or cerebrovascular accidents, were analyzed. Preprocedural and postprocedural changes in VAs were evaluated on follow-up contrast-enhanced CT. RESULTS: The overall 30-day mortality was 6.9% (2 of 29). None of the patients had SCI or a stroke of posterior circulation alone. Cerebrovascular accidents from embolic infarctions occurred in two patients (7.4%). Transient left arm ischemic symptoms were present in five patients (18.5%), but none required secondary interventions. Delayed development of type I endoleak occurred due to stent deformity in one patient, who underwent surgery. One patient required reintervention after the 10-month follow-up contrast-enhanced CT showed a pseudoaneurysm had developed at the distal margin of the previously placed stent graft. Hypertrophy of the right VA after TEVAR was seen in seven of 27 patients (25.9%); two patients showed bilateral hypertrophy of VAs. CONCLUSIONS: LSCA coverage without revascularization can be safely performed during TEVAR in patients with bilateral patent vertebrobasilar junctions. Hypertrophy of the right VA was noted in 25.9% of patients after LSCA coverage.