Abstract
Background: The management of aortic arch pathologies represents
a great challenge and is associated with high rates of mortality and
morbidity. The invasive and radical open surgical repair (OSR) is the
standard of care for this group of patients. A superior endovascular
approach via thoracic endovascular aortic repair (TEVAR) has been
introduced to treat arch pathologies with specifically designed
endografts. This approach was shown to benefit patients who are deemed
‘high risk’ for undergoing OSR as it is a greatly less invasiveness
option and thus, yields lower rates of morbidity and mortality.
Aims: This commentary aims to discuss the recent study by Tan et
al. which reports original data on the neurological outcomes after
endovascular repair of the aortic arch using the RELAY™ Branched device.
Methods: We carried out a literature search on multiple
electronic databases including PubMed, Ovid, Google Scholar, Scopus and
EMBASE in order to collate research evidence on the neurological
outcomes of endovascular aortic arch repair with TEVAR.
Results: Tan and colleagues showed through their original
clinical data that the RELAY™ Branched device has a high rate of
technical success and favourable neurological outcomes. There were no
reported neurological deficits in patients who received the
triple-branched RELAY™ Branched device.
Conclusion: The RELAY™ Branched endograft is well-established for
candidates for aortic arch endovascular repair with favourable
neurological outcomes. Multiple considerations can help control the
incidence of stroke following endovascular repair. These include
optimization of the supra-aortic vessels’ revascularization, weighting
the embolic risk in patients with atheromatous disease, and careful
preoperative assessment to select the best candidates for arch
endovascular repair.