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June 26, 2019

Low Rates of Neurologic Complications Seen in GREAT Registry of Gore's TEVAR Devices

June 26, 2019—In European Journal of Vascular and Endovascular Surgery (EJVES), Michele Piazza, MD, et al published findings from an evaluation of the incidence and predictors of early and midterm neurologic complications after thoracic endovascular aneurysm repair (TEVAR) in the GREAT registry.

Initiated in 2010, GREAT is a prospective, observational, multicenter registry of Gore & Associates' aortic endograft devices. The registry included only isolated thoracic aortic pathologies (aortic arch and descending thoracic aneurysms, type B dissections, penetrating ulcers, intramural hematomas, pseudoaneurysms, and transections). The registry excluded thoracoabdominal aneurysms and concomitant abdominal aneurysms.

Neurological complications were classified as cerebrovascular accidents (CVAs) and spinal cord injuries (SCIs). Clinical, procedural, and technical data were evaluated for their association with early (30 day) and midterm CVAs and SCIs.

As summarized in EJVES, the study was composed of 833 patients: 28 (3.4%) with arch aneurysms, 329 (39.5%) with descending thoracic aneurysms, 273 (32.8%) with type B dissections, and 203 (24.4%) with other thoracic pathologies. There were 593 (71.2%) elective procedures and 240 (28.8%) urgent procedures.

Aortic coverage > 20 cm was performed in 42.1% (n = 351); proximal landing zone 0-1-2 was adopted in 267 patients (32.1%), and of these, 98 (36.7%) underwent left subclavian artery (LSA) revascularization.

The investigators reported that there were 13 (1.5%) early CVA. The 4-year rate of freedom from CVA was 96.3%. On multivariable analysis, aortic arch aneurysm was the only independent predictor of early CVA (odds ratio, 16.7; P = .001). LSA coverage (hazard ratio [HR], 3.31; P = .005) and hypercholesterolemia (HR, 2.96; P = .024) were independent predictors of midterm ischemic CVA.

There were 15 (1.8%) early SCIs. The 4-year rate of freedom from SCI was 97.8%. No independent predictors of early SCI were identified, but length of coverage was an independent predictor of SCI at 4 years (HR, 1.24; P = .044).

In this real-world registry, the investigators found a low overall rate of neurologic complications after TEVAR for isolated thoracic aortic pathologies. Aortic arch aneurysms were associated with increased perioperative CVA risk. Length of coverage was an independent predictor of midterm SCI, as LSA coverage was associated with late CVA, concluded the investigators in EJVES.

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