Paraplegia Following Type B Acute Aortic Dissection Can Spare the Spinal Cord

Abstract Background Despite recent advances in diagnosis and management, the mortality of acute aortic dissection (AAD) remains high. Purpose This study aims to develop quality indicators (QIs) for the management of AAD, and to evaluate the associations between QIs and outcomes of AAD in a Japanese nationwide administrative database. Methods A total of 18,348 patients suffered from AAD (Type A: 10,131, Type B: 8,217) in the Japanese Registry of All Cardiac and Vascular Diseases database between 2012 and 2015 were studied. A systematic review was performed to establish initial index items for QIs. Evaluation was performed through the expert consensus meeting using a Delphi method. Associations between developed QIs and the mortality were determined by multivariate mixed logistic regression analyses. Results A total of nine QIs (five structural and four processatic) were developed. Achievements of developed QIs (High: 7–9, Middle: 4–6, Low: 0–3) were significantly associated with lower in-hospital mortality even after adjustment for covariates in both type A (Middle: odds ratio [OR], 0.257; 95% confidence interval [CI], 0.211–0.312; P<0.001; High: OR, 0.064; 95% CI, 0.047–0.086; P<0.001 vs. Low) and type B (Middle: OR, 0.447; 95% CI, 0.338–0.590; P<0.001; High: OR, 0.128; 95% CI, 0.077–0.215; P<0.001 vs. Low). Additionally, achievements of structural and processatic QIs were consistently associated with reduced in-hospital mortality. QIs and in-hospital mortality Conclusions Developed QIs for AAD management were significantly associated with lower in-hospital mortality. Evaluation of each hospital's management with QIs could be helpful to equalize quality of treatment and to fill the evidence-to-practice gaps in the real-world treatment.

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Spinal Cord Ischemia in the Setting of Acute Type B Aortic Dissection: Successful Rescue with Thoracic Endovascular Aortic Repair

Vascular and Endovascular Surgery ◽

10.1177/15385744211045156 ◽

2021 ◽

pp. 153857442110451

Author(s):

Masaki Kano ◽

Toru Iwahashi ◽

Toshiya Nishibe ◽

Kentaro Kamiya ◽

Hitoshi Ogino

Keyword(s):

Spinal Cord ◽

Aortic Dissection ◽

Medical Management ◽

Spinal Cord Ischemia ◽

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection

We report 2 cases of successful thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (ABAD) complicated with spinal cord ischemia (SCI). Case 1. A 70-year-old gentleman found with an uncomplicated ABAD with false lumen occluded, developed SCI shortly after admission during the initial medical management. Cerebrospinal fluid drainage (CSFD) was initiated followed by emergent TEVAR. SCI improved, and the patient was discharged. Case 2. A 52-year-old gentleman developed uncomplicated ABAD with patent false lumen. 5 hours after admission, he developed SCI during the initial medical management. Emergent TEVAR was performed followed by CSFD, and the SCI improved before discharge. These cases prompted us to address prompt TEVAR for primary entry closure and true lumen dilatation with postoperative hypertensive management to relieve the dynamic obstruction of the segmental arteries responsible for the compromised spinal cord circulation in complicated ABAD.

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Letter by Benedetto et al Regarding Article, “Importance of Refractory Pain and Hypertension in Acute Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection (IRAD)”

Circulation ◽

10.1161/circulationaha.110.991182 ◽

2011 ◽

Vol 123 (24) ◽

Author(s):

Umberto Benedetto ◽

Giovanni Melina ◽

Riccardo Sinatra

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Refractory Pain ◽

International Registry

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Two-stage Operation for Stanford Type B Acute Aortic Dissection with Renal Blood Flow Reduction

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.79.708 ◽

2018 ◽

Vol 79 (4) ◽

pp. 708-712

Author(s):

Yusuke SHIMIZU ◽

Susumu ISHIKAWA ◽

Hideki MISHIMA ◽

Yuki MATSUNAGA ◽

Yuki NISHIHARA ◽

...

Keyword(s):

Blood Flow ◽

Aortic Dissection ◽

Renal Blood Flow ◽

Acute Aortic Dissection ◽

Type B ◽

Two Stage ◽

Flow Reduction ◽

Blood Flow Reduction ◽

Stanford Type B

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Conservatively treated Type B intramural hematoma: Progression into acute aortic dissection followed by spontaneous resolution, assessed by CT

Radiology Case Reports ◽

10.2484/rcr.v9i2.929 ◽

2014 ◽

Vol 9 (2) ◽

pp. 929

Author(s):

Guadalupe Buitrago ◽

Sabina Vasaturo ◽

Lucia J.M. Kroft

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Intramural Hematoma ◽

Spontaneous Resolution ◽

Type B

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Abstract TP144: Mechanisms And Prognosis Of Acute Ischemic Stroke Related To Acute Aortic Dissection

Stroke ◽

10.1161/str.44.suppl_1.atp144 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Seung-Jae Lee ◽

Dong-Suk Shim ◽

Si-Ryung Han

Keyword(s):

Ischemic Stroke ◽

Aortic Dissection ◽

Early Onset ◽

Acute Aortic Dissection ◽

Type A ◽

Posterior Circulation ◽

Type B ◽

Delayed Onset ◽

Bilateral Carotid ◽

Type B Dissection

Background: Acute aortic dissection (AD) is one of the lethal cardiac diseases involving the aorta. Although pain is a typical symptom, stroke may not rarely occur with the occlusive dissection of aortic branches or hypotension under the condition of AD. We attempted to explores the clinical features, possible mechanisms and prognosis of acute ischemic stroke (AIS) related to AD Method: Medical records of 278 consecutive patients with AD (165 with type A and 113 with type B dissection) over 11.5 years were retrospectively analyzed for clinical history, CT or MRI findings and outcome. AIS were categorized into early- or delayed-onset stroke. Early-onset stroke was defined as an AIS presented at admission, and delayed-onset stroke was an AIS which were developed during the two months after the first admission. Results: 26 (9.4%) patients experienced an ischemic stroke, which included 22 with type A and 4 with type B dissection. 8 patients (2.9%) including a case of TIA had an early-onset stroke, whereas delayed-onset stroke occurred in 18 patients (6.5%) postoperatively or under medical treatment. Early-onset stroke was all referable to the anterior circulation, predominantly right-sided (87.5%). One or more main branches of the aortic arch were involved in 6 out of 8 patients (75%) with early-onset stroke. Innominate artery was most frequently involved (75.0%). In contrast, delayed-onset stroke affected similarly bilateral carotid territories, and also included lesions in bilateral carotid, posterior-circulation and anterior/posterior-circulation territories. Among the 26 patients, 8 patients (30.8%) expired within 6 months of the disease onset (3 cases from hemispheric stroke with brain herniation, 2 cases from aortic rupture, 2 cases from sepsis with multiple organ failure and a case from mesentery ischemia and renal failure). Additionally, 9 patients (34.6%) remained functionally dependent six months later. Conclusion: AD not infrequently causes AIS with grave prognosis, especially in patients with type A dissection. The presumed mechanisms were aortic branch dissection causing luminal occlusion and emboli from thrombosed vascular lumen and hypotension under the condition of AD.

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Endovascular repair or best medical treatment: what is the optimal management of uncomplicated Type-B acute aortic dissection?

Journal of Thoracic Disease ◽

10.21037/jtd.2017.08.145 ◽

2017 ◽

Vol 9 (10) ◽

pp. 3458-3462 ◽

Cited By ~ 1

Author(s):

María Elena Arnáiz-García ◽

José María González-Santos ◽

Ana María Arnáiz-García ◽

Javier Arnáiz

Keyword(s):

Aortic Dissection ◽

Medical Treatment ◽

Endovascular Repair ◽

Acute Aortic Dissection ◽

Optimal Management ◽

Type B ◽

Best Medical Treatment

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Spinal subarachnoid hemorrhage in type B aortic dissection: a rare presentation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320901935 ◽

2020 ◽

Vol 28 (3) ◽

pp. 175-178

Author(s):

Meenakshi M Subbiah ◽

Bashi V Velayudhan

Keyword(s):

Spinal Cord ◽

Subarachnoid Hemorrhage ◽

Aortic Dissection ◽

Spinal Cord Ischemia ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Aortic Diseases ◽

Rare Presentation ◽

Spinal Subarachnoid Hemorrhage

Paraplegia is a common complication encountered during surgical and endovascular repair of aortic diseases. At times, it is also a presenting feature of aortic dissection. Involvement of more than one spinal blood supply system is the most common cause of spinal cord ischemia. Proper planning is needed to prevent and treat spinal cord ischemia. We report this rare case of acute type B aortic dissection that presented with paraplegia due to a spinal subarachnoid hemorrhage.

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