Objective: To investigate whether intentional left subclavian artery (LSA) coverage during thoracic endovascular aortic repair (TEVAR) increases the incidence of short-term postoperative cerebral infarction and paraplegia and risk of long-term postoperative cerebral infarction. Methods: The clinical data of 629 patients undergoing TEVAR from January 2004 to March 2013 were retrospectively analyzed. Of the patients, LSA coverage was not performed in 399 cases, partial LSA coverage was performed in 63 cases, and complete LSA coverage without and with revascularization was performed in 159 and 8 cases, respectively. The incidences of short-term postoperative cerebral infarction and paraplegia between patients with and without LSA coverage were compared by univariate analysis, and the risk factors for long-term postoperative cerebral infarction was determined by multivariate Logistic regression analysis. Results: Among the 629 patients, no severe ischemia of the upper limb developed after surgery; postoperative cerebral ischemia occurred in 3 cases (5%) that included 2 cases (0.5%) without LSA coverage and 1 case (0.4%) with LSA coverage; postoperative paraplegia occurred in 4 cases (0.6%) that comprised 3 cases (0.8%) without LSA coverage and 1 case (0.4%) with LSA coverage, and the incidences of short-term postoperative cerebral infarction and paraplegia between patients with and without LSA coverage had no statistical difference (both P>0.05). The average period of follow-up was 31.4 (1–123) months, and the multivariate analysis demonstrated that LSA coverage did not increase the risk of long-term postoperative cerebral infarction (OR=1.03, P=0.088), but it was somewhat increased in patients with a preoperative history of cerebral ischemia and those older than 70 years of age (OR=3.41, P=0.023 ; OR=1.90, P=0.034). Conclusion: Left upper limb can well tolerate the LSA coverage, and LSA coverage may not increase the incidence of short-term postoperative cerebral infarction and paraplegia and risk of long-term postoperative cerebral infarction.