This study states that A significant percentage of patients undergoing TEVAR have aneurysms that involve the origin of the LSA, which necessitates coverage of the LSA for adequate seal. LSA coverage may be associated with increased stroke incidence because of reduction of blood flow to the left vertebral artery, which may cause cerebrovascular ischemia, and delivery of stent grafts across the origin of the arch vessels, which may lead to embolization into the cerebral circulation. The authors refer to two recent meta-analyses that demonstrated LSA revascularization did not lower the stroke incidence after TEVAR. The authors question whether routine LSA revascularization should be performed when LSA coverage is necessary during TEVAR. I want to emphasize three weaknesses of the study. Some of the patients in the TEVAR with LSA coverage without concomitant revascularization group underwent staged procedures at two different settings. Because patients experiencing serious adverse events during the first procedure were less likely to undergo the second stage of their procedure, the true stroke incidence may be even higher in these patients. A second weakness of the paper is an inherent problem found with any retrospective large database such as the National Surgical Quality Improvement Program, in which there are different patient variables in each group. A third weakness is that the authors did not analyze whether LSA revascularization was beneficial in preventing spinal ischemia.
Reference link- https://www.jvascsurg.org/article/S0741-5214(20)31350-1/fulltext
