Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results From the STEP Registry

Advances in neuromonitoring and related screening by imaging constitute an expanding field of cardiovascular perioperative care, attracting the readership of interventional and conventional surgical providers. This pilot retrospective case series from two European hospitals provides some up to date insight to cerebral findings that are by and large 1:  bi-spherical (and hence difficult to attribute to particle or gaseous embolization) and 2: anatomically related to the middle cerebral artery. It will be useful to discern , in this or a larger cohort of the ‘Stroke from thoracic endovascular procedures’ Registry, the theory and causation of the ‘silent’ (albeit including two TIA’s and one possible paraplegic) bilateral lesions, and any association to current endovascular practice : a simple research idea would be to re-scan the subjects and obtain a robust neurocognitive follow-up by any of the relevant batteries ( sickness-impact-profile , Hopkins Verbal Learning Test, Rey Auditory Verbal Learning Test or other questionnaire ). The interval between TEVAR and imaging may have masked Transient Neurological Events. The exact anatomy, especially the variations of the Circe of Willis, may provide further opportunities for patient-centred research.