Association Between Preoperative Cerebrovascular High-Risk Status and Long-Term Ischemic Stroke After EVAR

Objective: To investigate the impact of asymptomatic high-risk status for ischemic stroke on patients with abdominal aortic aneurysm undergoing endovascular aortic repair (EVAR). Methods: Eligible patients with abdominal aortic aneurysm who underwent EVAR between January 2011 and December 2021 were enrolled in this retrospective cohort study. Propensity score matching (PSM) was used to balance baseline characteristics between the cerebrovascular high-risk group and the standard control group. The impact of cerebrovascular high-risk status on short- and long-term outcomes was assessed using Cox proportional hazards regression and generalized linear models, with results presented as hazard ratios (HRs), odds ratios (ORs), and corresponding 95% confidence intervals (CIs). Results: A total of 1080 patients were included (299 high-risk, 781 standard). During the 13-year follow-up period, ischemic stroke occurred in 45 patients (15.1%) in the high-risk group (HR, 7.01; 95% CI, 4.11–11.94; p < 0.001). The high-risk group also had a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs), which occurred in 129 patients (43.1%) (HR, 1.78; 95% CI, 1.43–2.24; p < 0.001). These findings remained consistent across inverse probability of treatment weighting (IPTW) and propensity score matching combined with multivariable generalized linear model (PSM+MVA-GLM) analyses. Conclusions: Although no significant increase in perioperative cerebrovascular adverse events was observed in asymptomatic patients with a preoperative cerebrovascular high-risk status, their worse long-term prognosis appears to be associated with this risk status. This association highlights the need for rigorous cardiovascular and cerebrovascular risk management in this vulnerable population after surgery.