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Peer-reviewedCC BYJTCVS open

When stroke strikes: Predictors of stroke after open thoracoabdominal aortic aneurysm repair.

  • Kyle W Blackburn1
  • Dominique I Cope1
  • Benjamin R Zambetti1
  • Veronica A Glover2
  • Susan Y Green2
  • Lauren K Barron1,3
  • Anna H Xue1,3
  • Vicente Orozco-Sevilla1,3
  • Subhasis Chatterjee1,4,5,6
  • Marc R Moon1,4,5,6
  • Joseph S Coselli1,4,5,6
6 affiliations
  1. 1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
  2. 2Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
  3. 3Department of Cardiothoracic Surgery, Michael E. DeBakey Department of Veterans Affairs Medical Center, Houston, Tex.
  4. 4The Texas Heart Institute at Baylor College of Medicine, Houston, Tex.
  5. 5Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex.
  6. 6Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex.
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Abstract

Objective

Postoperative stroke after thoracoabdominal aortic aneurysm (TAAA) repair is an uncommon but devastating complication that has been understudied. This analysis aimed to identify patients at greatest risk for ischemic or hemorrhagic stroke after TAAA repair.Methods

We analyzed data from 3765 patients who underwent open TAAA repair from 1986 to 2024 at a single high-volume aortic surgery practice. We used multivariable logistic regression modeling to evaluate preoperative and operative predictors of all and persistent ischemic and hemorrhagic stroke. The effect of new-onset atrial fibrillation was evaluated.Results

Postoperative stroke persisted to death or hospital discharge in 93 patients (2.5%) and was transient in 29 (0.8%). Those with persistent stroke had a greater mortality rate (61.3%, n = 57/93) than those without any stroke (7.3%, n = 267/3643). Most persistent strokes were ischemic (76.3%) rather than hemorrhagic (26.9%). Significant predictors of persistent ischemic stroke included older age (odds ratio [OR], 1.04; P = .007) and chronic kidney disease (OR, 1.98; P = .01), whereas Crawford extent III (OR, 0.38; P = .01) and IV repairs (OR, 0.35; P = .008) were protective. Significant predictors of persistent hemorrhagic stroke included heritable thoracic aortic disease (OR, 2.34; P = .04) and prophylactic cerebrospinal fluid drainage (OR, 7.99; P = .006). Prolonged aortic clamp time (OR, 1.03, P = .03) was associated with greater odds of death after a stroke.Conclusions

This analysis of a large, single-practice series identified variables associated with stroke and stroke-related mortality after TAAA repair. Although stroke remains infrequent, its lethality highlights the importance of risk modeling. Mitigating the risk of hemorrhagic stroke in patients with heritable thoracic aortic disease should be prioritized.

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Cite

BibTeXRIS
BibTeX
@article{blackburn2026when,
  title = {{When stroke strikes: Predictors of stroke after open thoracoabdominal aortic aneurysm repair.}},
  author = {Kyle W Blackburn and Dominique I Cope and Benjamin R Zambetti and Veronica A Glover and Susan Y Green and Lauren K Barron and Anna H Xue and Vicente Orozco-Sevilla and Subhasis Chatterjee and Marc R Moon and Joseph S Coselli},
  journal = {JTCVS open},
  year = {2026},
  month = aug,
  doi = {10.1016/j.xjon.2026.102057},
  url = {https://europepmc.org/article/MED/42948061},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - When stroke strikes: Predictors of stroke after open thoracoabdominal aortic aneurysm repair.
AU  - Kyle W Blackburn
AU  - Dominique I Cope
AU  - Benjamin R Zambetti
AU  - Veronica A Glover
AU  - Susan Y Green
AU  - Lauren K Barron
AU  - Anna H Xue
AU  - Vicente Orozco-Sevilla
AU  - Subhasis Chatterjee
AU  - Marc R Moon
AU  - Joseph S Coselli
PY  - 2026
DA  - 2026/08/13
JO  - JTCVS open
DO  - 10.1016/j.xjon.2026.102057
UR  - https://europepmc.org/article/MED/42948061
AB  - Objective  Postoperative stroke after thoracoabdominal aortic aneurysm (TAAA) repair is an uncommon but devastating complication that has been understudied. This analysis aimed to identify patients at greatest risk for ischemic or hemorrhagic stroke after TAAA repair.Methods  We analyzed data from 3765 patients who underwent open TAAA repair from 1986 to 2024 at a single high-volume aortic surgery practice. We used multivariable logistic regression modeling to evaluate preoperative and operative predictors of all and persistent ischemic and hemorrhagic stroke. The effect of new-onset atrial fibrillation was evaluated.Results  Postoperative stroke persisted to death or hospital discharge in 93 patients (2.5%) and was transient in 29 (0.8%). Those with persistent stroke had a greater mortality rate (61.3%, n = 57/93) than those without any stroke (7.3%, n = 267/3643). Most persistent strokes were ischemic (76.3%) rather than hemorrhagic (26.9%). Significant predictors of persistent ischemic stroke included older age (odds ratio [OR], 1.04; P = .007) and chronic kidney disease (OR, 1.98; P = .01), whereas Crawford extent III (OR, 0.38; P = .01) and IV repairs (OR, 0.35; P = .008) were protective. Significant predictors of persistent hemorrhagic stroke included heritable thoracic aortic disease (OR, 2.34; P = .04) and prophylactic cerebrospinal fluid drainage (OR, 7.99; P = .006). Prolonged aortic clamp time (OR, 1.03, P = .03) was associated with greater odds of death after a stroke.Conclusions  This analysis of a large, single-practice series identified variables associated with stroke and stroke-related mortality after TAAA repair. Although stroke remains infrequent, its lethality highlights the importance of risk modeling. Mitigating the risk of hemorrhagic stroke in patients with heritable thoracic aortic disease should be prioritized.
SN  - 2666-2736
ER  -