Abstract 280: Cocaine-Related Aortic Dissection: Lessons from the International Registry of Acute Aortic Dissection

Background: Acute Aortic Dissection (AAD) associated with cocaine use is a rare event for which only limited case reports and small cohort studies are available. This study compares demographics, history, presenting symptoms and in-hospital outcomes among AAD patients with a history of cocaine use (C+) to those of patients without a history of cocaine use (C-) in a large international registry. Methods: Our study analyzed 3584 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2012. We divided the population based on documented cocaine use and further stratified patients into Type A (33 C+/2332, 1.4%) and Type B (30 C+/1252, 2.4%) dissection cohorts. Results: C+ patients presented at a younger age and were more likely to be male and black for both Type A and B dissections. Type B dissection was more common among C+ patients than in C- patients. Cocaine-related AAD was reported more often at US sites compared to European sites (86.4% 51/63 v. 13.6% 8/63, p<0.001). Tobacco use was more prevalent in the C+ cohort. No differences were seen in history of hypertension, known atherosclerosis or time from symptom onset to presentation between cohorts. Type B C+ patients were more likely to be hypertensive at presentation. Both Type A and Type B C+ cohorts had significantly smaller ascending aortic diameters than C- patients. Acute renal failure was more common in Type A C+ patients but mortality was significantly lower in Type A C+ patients vs type C- patients for reasons than could not be identified from the data base. Conclusions: Cocaine abuse is implicated in approximately 2% of patients with acute aortic dissection. The typical patient is a relatively young male cigarette smoker, who like the majority of patients with AAD, has a history of hypertension. In hospital mortality for cocaine-related Type A dissection is lower than that seen with non-cocaine related type A dissection. The combination of tobacco use, cocaine use, and hypertension may predispose patients to AAD who may otherwise have little risk for the condition.

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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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JOHN RITTER SYNDROME – ACUTE TYPE A DISSECTION CAUSING ACUTE MYOCARDIAL INFARCTION: INSIGHTS FROM THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION (IRAD)

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(12)61902-0 ◽

2012 ◽

Vol 59 (13) ◽

pp. E1901

Author(s):

Lindsay Hagan ◽

Kevin Greason ◽

Artur Evangelista Masip ◽

Daniel Montgomery ◽

Patrick O'Gara ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Acute Type ◽

Acute Type A Dissection ◽

International Registry ◽

Type A Dissection

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DEBAKEY TYPES I AND II ARE DISTINCT SUBSETS WITHIN TYPE A DISSECTION: A REPORT FROM THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)61520-x ◽

2013 ◽

Vol 61 (10) ◽

pp. E1520

Author(s):

Nilla Majahalme ◽

Louis Kohl ◽

Artur Evangelista Masip ◽

Mark Russo ◽

Stuart Hutchison ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

International Registry ◽

Type A Dissection

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Ascending Thoracic Aorta Dimension and Outcomes in Acute Type B Dissection (from the International Registry of Acute Aortic Dissection [IRAD])

The American Journal of Cardiology ◽

10.1016/j.amjcard.2010.09.020 ◽

2011 ◽

Vol 107 (2) ◽

pp. 315-320 ◽

Cited By ~ 23

Author(s):

Anna M. Booher ◽

Eric M. Isselbacher ◽

Christoph A. Nienaber ◽

James B. Froehlich ◽

Santi Trimarchi ◽

...

Keyword(s):

Aortic Dissection ◽

Thoracic Aorta ◽

Acute Aortic Dissection ◽

Acute Type ◽

Type B ◽

International Registry ◽

Type B Dissection

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EP.WE.202Atypical presentation of Acute Aortic Dissection Standford type A dissection

British Journal of Surgery ◽

10.1093/bjs/znab308.027 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Su Kwan Lim ◽

Neville Ekpete

Keyword(s):

Mortality Rate ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Surgical Intervention ◽

Type A ◽

Radiological Imaging ◽

Case Presentation ◽

History Of ◽

Type A Dissection ◽

Hospital Team

Abstract Introduction Acute aortic dissection type A (AADA), a tear in the intima lining of the aorta, is a surgical emergency and contributes to high mortality rate if not managed promptly with surgical intervention. Case presentation We describe a case of a 63-year-old female with a history of hypertension presented with presumed seizure and hypotension to the emergency department. She did not have Computed Tomography (CT) chest despite having hemopericardium on her CT abdomen and pelvis. Her condition deteriorated to pericardial effusion, cardiac tamponade, multi-organ failure and shock. A diagnosis of AADA was only found on the stage of post-mortem. Conclusion AADA may not present with classical symptoms of tearing chest pain. The combination of hypotension and neurological deficit should trigger hospital team to consider aortic dissection higher up in the differential diagnosis for shock. If there is unclear diagnosis for an acutely unwell patient, hospital team should review the case and radiological imaging again. Hemopericardium on CT abdomen, pelvis should trigger hospital team to request for a CT chest to look out for the cause of hemopericardium. AADA is fatal without prompt surgical intervention. Immediate diagnosis can significantly reduce the mortality rate.

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Insights from the International Registry of Acute Aortic Dissection

Global Cardiology Science and Practice ◽

10.21542/gcsp.2016.8 ◽

2016 ◽

Vol 2016 (1) ◽

Author(s):

Arturo Evangelista ◽

Giuliana Maldonado ◽

Doménico Gruosso ◽

Gisela Teixido ◽

Jose Rodríguez-Palomares ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Ascending Aorta ◽

University Of Michigan ◽

Type B ◽

Clinical Observations ◽

International Registry ◽

Diagnostic Management ◽

The University

The International Registry of Acute Aortic Dissection (IRAD) was established in 1996 for the purpose of enrolling patients at large referral centres to assess the presentation, management and outcomes of acute aortic dissection (AAD). Data on presentation, diagnostic, management and outcomes were initially collected by 12 centres and then extended to 28 referral centres. All data of more than 5,000 cases were reviewed and analysed by the IRAD Coordinating Center at the University of Michigan. Since the first publication in 2000, IRAD investigators have reported a number of clinical observations, in more than 70 publications. This article will cover most of these points highlighting the findings of IRAD in patients with type A (with ascending aorta involvement) and type B (without ascending aorta involvement) AAD.

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P5599Prognostic impact of quality indicators on outcomes of acute aortic dissection in Japan

European Heart Journal ◽

10.1093/eurheartj/ehz746.0543 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Yamaguchi ◽

M Nakai ◽

Y Sumita ◽

Y Miyamoto ◽

H Matsuda ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Quality Indicators ◽

Acute Aortic Dissection ◽

Vascular Diseases ◽

Type A ◽

Administrative Database ◽

Type B ◽

Practice Gaps

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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Acute Aortic Dissection in Pregnancy in a Woman with Undiagnosed Marfan Syndrome

Case Reports in Obstetrics and Gynecology ◽

10.1155/2012/490169 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Mandana Master ◽

Gavin Day

Keyword(s):

Aortic Dissection ◽

Marfan Syndrome ◽

Acute Aortic Dissection ◽

Congenital Abnormalities ◽

Surgical Repair ◽

Phenotypic Expression ◽

Sudden Onset ◽

Lower Segment Caesarean Section ◽

Type B Dissection ◽

Type A Dissection

We report a case of acute aortic dissection in a lady of 28 weeks of gestation with undiagnosed Marfan syndrome. The patient had been seen in our antenatal clinics. Her history documented in her pregnancy record was negative for genetic/congenital abnormalities. There was no family history documented. Subsequently, at 28 weeks of gestation, the patient presented with sudden onset chest, jaw, and back pain. Further history revealed that her father had died at the age of 27 of an aortic dissection. Echocardiography showed aortic root dissection with occlusion of aortic branches. She subsequently underwent an emergency lower segment caesarean section followed by surgical repair of type A dissection. A simultaneous type B dissection was managed conservatively. On later examination, our patient fulfilled the diagnostic criteria for phenotypic expression of Marfan syndrome. Genetic testing also confirmed that she has a mutation of the fibrillin (FBN 1) gene associated with the disease.

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