Neurologic events, including stroke and paraplegia, are critical clinical concerns when descending thoracic aneurysm repair is considered. These well-recognized complications occur after open surgical repair and TEVAR, and often lead to the eventual death of the patient.

The guideline developers placed a relatively higher value on preventing these catastrophic complications and a relatively lower value on less devastating perioperative complications of LSA revascularization.

They also placed a relatively high value on avoiding stroke and paraplegia in the clinical context of decision making with very low-quality evidence, but tempered the strength of the recommendation because of the quality of the evidence.

The role of these values was particularly emphasized in the case of selected patients who have an anatomy that compromises perfusion to critical organs. In this case, the committee made a stronger recommendation, despite the paucity of evidence, to prevent these complications.