Preventing Stroke Due to Intervention in the Aortic Arch

Abstract

Stroke following endovascular intervention can be both clinically apparent and “silent”, detected incidentally on imaging. Silent brain infarcts (SBI) can be detected in up to 67%–80% patients undergoing thoracic aortic interventions.1,2 Why so many SBI do not lead to more apparent neurological deficits is a kind of miracle, as their distribution in the cerebral vascular bed is random. Their long term implications for cognitive decline are concerning but poorly defined, largely due to a lack of controlled studies with pre- and post-operative diffusion weighted MRI (DW-MRI), and medium to long term cognitive assessments.