Association of Subclavian Artery Blood Flow with Stroke After Thoracic Endovascular Aortic Repair with Single-Branch Stent Graft

Purpose: To investigate the stroke risk factors following thoracic endovascular aortic repair (TEVAR) with a single-branch stent graft. Materials and Methods: We retrospectively analyzed 128 patients of acute aortic syndromes with inadequate proximal landing zones (PLZ) who underwent TEVAR from September 2019 to December 2023. Patient survival was evaluated using the Kaplan-Meier method, and the relationship between subclavian artery patency and stroke incidence was determined through Cox regression analysis. Results: Technical success rates for aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) were 98.3%, 100%, and 100%, respectively. There were no significant differences in surgery duration, hospital stay, stent length, and oversize across the groups. Over an 18-month follow-up, there were no significant differences in mortality, stroke incidence, or re-intervention rates among the groups. The rates of stroke post-treatment were 4.9% for AD, 11.8% for IMH, and 12.0% for PAU. Notably, subclavian artery stenosis increased the stroke risk by 37.94 times (hazard ratio, 37.94; 95% CI: 4.76-302.35; p < 0.001). Female patients had a 16.57-fold increased risk of stroke (hazard ratio: 16.57; 95% CI: 1.00-272.88; p = 0.049). In addition, each standard deviation increase in operation time raised the stroke rate by 1.03 times (hazard ratio: 1.03; 95% CI: 1.001-1.05; p = 0.003). Subclavian artery stenosis also significantly increased the risk of re-intervention by 44.14 times (hazard ratio: 44.14; 95% CI: 7.50-259.73; p < 0.001), with significant differences in re-intervention rates among the 3 groups, notably improved in the PAU group compared to the AD group (hazard ratio: 3.60; 95% CI: 1.01-12.82; p = 0.042). Conclusion: This study underscores the critical importance of maintaining subclavian artery branch patency post-TEVAR to mitigate stroke and re-intervention risks.