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• W4238259442 abstract "The authors would like to thank Dr Khoynezhad [1Khoynezhad A. Stroke rate after thoracic endovascular aortic repair may not be equal among various aortic pathologies.Ann Thorac Surg. 2008; 86 (letter): 2023Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] for his comments regarding our article [2Gutsche J.T. Cheung A.T. McGarvey M.L. et al.Risk factors for perioperative stroke after thoracic endovascular aortic repair.Ann Thorac Surg. 2007; 84: 1195-1200Abstract Full Text Full Text PDF PubMed Scopus (169) Google Scholar]. He has raised some important points that we would like to address. In our publication, Table 1 was constructed to estimate the incidence of stroke associated with thoracic endovascular aortic repair (TEVAR) for a representative patient population based on the published experience in the medical literature. We acknowledge that the values entered into Table 1 corresponded to the incidence of stroke reported after TEVAR for aortic aneurysm only from Dr Khoynezhad's published series (Table 1 [3Khoynezhad A. Donayre C.E. Bui H. Kopchok G.E. Walot I. White R.A. Risk factors of neurologic deficit after thoracic aortic endografting.Ann Thorac Surg. 2007; 83: S882-S889Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar]). We agree with Khoynezhad [1Khoynezhad A. Stroke rate after thoracic endovascular aortic repair may not be equal among various aortic pathologies.Ann Thorac Surg. 2008; 86 (letter): 2023Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] that the values reported in Table 1 may have represented only a subgroup analysis from their report of 184 TEVAR procedures performed in 153 patients. According to Khoynezhad's report, the estimated incidence of stroke after TEVAR for their entire experience should be revised to 8 strokes per 184 TEVAR operations (4.3%) or 8 strokes in 153 patients undergoing TEVAR operations (5.2%) [3Khoynezhad A. Donayre C.E. Bui H. Kopchok G.E. Walot I. White R.A. Risk factors of neurologic deficit after thoracic aortic endografting.Ann Thorac Surg. 2007; 83: S882-S889Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar]. With further review of Table 1 in our publication, the total number of patients in the Talent Thoracic Retrospective Registry [4Fattori R. Nienaber C.A. Rousseau H. et al.Results of endovascular repair of the thoracic aorta with the talent thoracic stent graft: the Talent Thoracic Retrospective Registry.J Thorac Cardiovasc Surg. 2006; 132: 332-339Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar] should be revised to be 457 rather than 422 that indicated the number of survivors. Adjusting for the total number of patients and procedures reported in Khoynezad's series would revise our estimate of stroke associated with TEVAR to be 3.9% of patients or 3.8% of procedures. The authors also acknowledge that the stroke risk associated with TEVAR may be different among each of the various aortic pathologies amenable to treatment with endovascular stent graft repair. Patients undergoing TEVAR for degenerative fusiform aneurysms associated with aortic atherosclerotic disease would likely be at greater risk of having high-grade atheroma with the potential for an embolization and stroke. Patients undergoing TEVAR for aortic diseases not associated with atherosclerosis (such as traumatic aortic injury) may be at lower risk of perioperative stroke. For example, the incidence of perioperative stroke in the subset of patients undergoing TEVAR for aortic dissection and aortic transection in Khoynezhad's series was 3.7% (3 of 79) compared with 5.5% (5 of 91) in those undergoing TEVAR for aortic aneurysm [3Khoynezhad A. Donayre C.E. Bui H. Kopchok G.E. Walot I. White R.A. Risk factors of neurologic deficit after thoracic aortic endografting.Ann Thorac Surg. 2007; 83: S882-S889Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar]. Similarly, the incidence of perioperative stroke after TEVAR in the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair registry and United Kingdom Thoracic Endograft Series was 2.8% (7 of 249) for aortic aneurysm, 1.5% (2 of 131) for aortic dissection, and 2% (1 of 50) for traumatic rupture [5Fattori R. Nienaber C.A. Rousseau H. et al.Talent Thoracic Retrospective Registry Results of endovascular repair of the thoracic aorta with the talent thoracic stent graft: the Talent Thoracic Retrospective Registry.J Thorac Cardiovasc Surg. 2006; 132: 332-339Abstract Full Text Full Text PDF PubMed Scopus (254) Google Scholar]. Stroke Rate After Thoracic Endovascular Aortic Repair May Not Be Equal Among Various Aortic PathologiesThe Annals of Thoracic SurgeryVol. 86Issue 6PreviewI read with interest the article by Gutsche and colleagues [1] evaluating risk factors of stroke after thoracic endovascular aortic repair (TEVAR). Dr Gutsche and coauthors have misquoted our results in Table 1 [1]. The authors report 91 patients undergoing TEVAR with a stroke rate of 5.5%, quoting a subgroup analysis of our manuscript including only aneurysms [2]. In fact, the postprocedural stroke was found in 8 of 184 consecutive patients in our series, with a stroke rate of 4.3% [2]. Six of 8 patients with postprocedural stroke had a grading of 4 to 5 in the thoracic aorta, and 7 of 8 patients had either atherosclerotic aneurysm or calcified chronic type B aortic dissection [2]. Full-Text PDF" @default.
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• W4238259442 title "Reply" @default.
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