Acute aortic syndrome (AAS) requiring aortic arch reconstruction is associated with a risk of early postoperative ischemic stroke despite advances in endovascular and hybrid techniques. A retrospective cohort study published in the Frontiers in Cardiovascular Medicine assessed the relationship between procedure duration and 30-day stroke in patients undergoing arch reconstruction. 

Consecutive patients treated between January 2017 and December 2023 with either Zone 2 single-branch stent-assisted thoracic endovascular aortic repair (TEVAR) or hybrid supra-aortic debranching followed by TEVAR were included.

The primary endpoint was imaging-confirmed ischemic stroke within 30 days post-procedure. Multivariable regression models adjusted for age, sex, body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), prior stroke, and renal insufficiency were used to evaluate associations. Receiver operating characteristic (ROC) analysis assessed the discriminative performance of procedure duration.

A total of 235 patients (mean age 60.7±10.6 years; 84.7% male) were analyzed. Procedure duration was significantly longer in the hybrid group compared with the Zone 2 single-branch TEVAR group (249.0±72.3 vs 110.4±43.3 minutes; P<0.001). Early postoperative stroke occurred in 7.2% of patients, with higher incidence in the hybrid group (11.1%) compared with the TEVAR group (3.9%; P=0.034). Longer procedure duration was independently associated with increased stroke risk (adjusted HR 1.012 per minute; 95% CI 1.006–1.018; P<0.001).

Exploratory analysis identified a procedure duration threshold of 273 minutes with good discrimination for early stroke (AUC 0.81). These findings indicate that longer procedures are associated with increased early stroke risk after AAS arch reconstruction.