Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 28;19(1):402.
doi: 10.1186/s13019-024-02932-3.

Optimal antiplatelet therapy after revascularization of left subclavian artery during TEVAR

Mengxiao Shi  1 , Hong Fang  1 , Ying Wu  1 , Han Li  2 , Chong Sheng  3 , Shuchun Li  4 , Qing Zhou  5   6   7
Affiliations

Optimal antiplatelet therapy after revascularization of left subclavian artery during TEVAR

Mengxiao Shi et al. J Cardiothorac Surg. .

Abstract

Background: Thoracic endovascular aortic repair (TEVAR) is a minimally invasive technique used to treat type B aortic dissections. Left subclavian artery (LSA) reconstruction is required when treating patients with involvement of LSA. The best antiplatelet therapy after LSA reconstruction is presently uncertain.

Methods: This study retrospectively analyzed 245 type B aortic dissection patients who underwent left subclavian artery revascularization during TEVAR. Out of 245 patients, 159 (64.9%) were in the single antiplatelet therapy (SAPT) group, receiving only aspirin, and 86 (35.1%) were in the dual antiplatelet therapy (DAPT) group, receiving aspirin combined with clopidogrel. During the 6-month follow-up, primary endpoints included hemorrhagic events (general bleeding and hemorrhagic strokes), while secondary endpoints comprised ischemic events (left upper limb ischemia, ischemic stroke, and thrombotic events), as well as death and leakage events. Both univariate and multivariate Cox regression analyses were performed on hemorrhagic and ischemic events, with the Kaplan-Meier method used to generate the survival curve.

Results: During the six-month follow-up, the incidence of hemorrhagic events in the DAPT group was higher (8.2% vs. 30.2%, P < 0.001). No significant differences were observed in ischemic events, death, or leakage events among the different antiplatelet treatment schemes. Multivariate Cox regression analysis showed that DAPT (HR: 2.22, 95% CI: 1.07-4.60, P = 0.032) and previous chronic conditions (HR:3.88, 95% CI: 1.24-12.14, P = 0.020) significantly affected the occurrence of hemorrhagic events. Chronic conditions in this study encompassed depression, vitiligo, and cholecystolithiasis. Carotid subclavian bypass (CSB) group (HR:0.29, 95% CI: 0.12-0.68, P = 0.004) and single-branched stent graft (SBSG) group (HR:0.26, 95% CI: 0.13-0.50, P < 0.001) had a lower rate of ischemic events than fenestration TEVAR (F-TEVAR). Survival analysis over 6 months revealed a lower risk of bleeding associated with SAPT during hemorrhagic events (P = 0.043).

Conclusions: In type B aortic dissection patients undergoing LSA blood flow reconstruction after synchronous TEVAR, the bleeding risk significantly decreases with the SAPT regimen, and there is no apparent ischemic compensation within 6 months. Patients with previous chronic conditions have a higher risk of bleeding. The CSB group and SBSG group have less ischemic risk compared to F-TEVAR group.

Keywords: Antiplatelet; Aortic dissection; Aspirin; Clopidogrel; Left subclavian artery revascularization; TEVAR.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Consort diagram of patient screening and allocation
Fig. 2
Fig. 2
Survival analysis of hemorrhagic and ischemic events. DAPT = dual-antiplatelet therapy. SAPT = single-antiplatelet therapy. (A) Analysis results of hemorrhagic event. (B) Analysis results of ischemic event
Fig. 3
Fig. 3
Forest map of univariate and multivariate hemorrhagic events
Fig. 4
Fig. 4
Forest map of univariate and multivariate ischemic events
See this image and copyright information in PMC

References

    1. Volodos NL, Karpovich IP, Troyan VI, Kalashnikova Y, Shekhanin VE, Ternyuk NE, Neoneta AS, Ustinov NI, Yakovenko LF. Clinical experience of the use of self-fixing synthetic prostheses for remote endoprosthetics of the thoracic and the abdominal aorta and iliac arteries through the femoral artery and as intraoperative endoprosthesis for Aorta Reconstruction. Vasa Suppl. 1991;33:93–5. - PubMed
    1. Xie W, Xue Y, Li S, Jin M, Zhou Q, Wang D. Left subclavian artery revascularization in thoracic endovascular aortic repair: single Center’s clinical experiences from 171 patients. J CARDIOTHORAC SURG. 2021;16(1):207. doi: 10.1186/s13019-021-01593-w. - DOI - PMC - PubMed
    1. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DJ, A Report of the American College of Cardiology Foundation/American Heart Association Task Force On Practice Guidelines, American Association for Thoracic Surgery. 2010 Accf/Aha/Aats/Acr/Asa/Sca/Scai/Sir/Sts/Svm Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease., American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. J AM Coll Cardiol. 2010; 55(14):e27-e129. 10.1016/j.jacc.2010.02.015. - PubMed
    1. Riambau V, Bockler D, Brunkwall J, Cao P, Chiesa R, Coppi G, et al. editors. ‘s Choice - Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (Esvs). Eur J Vasc Endovasc. 2017; 53(1):4–52. 10.1016/j.ejvs.2016.06.005. - PubMed
    1. Upchurch GJ, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, et al. Society for vascular surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J VASC SURG. 2021;73(1S):S55–83. doi: 10.1016/j.jvs.2020.05.076. - DOI - PubMed

MeSH terms