Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

2020 ◽  
Author(s):  
Hongliang Zhao ◽  
Fan Guo ◽  
Jingji Xu ◽  
Yuanqiang Zhu ◽  
Didi Wen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Cerebral Infarction ◽  
Aortic Arch ◽  
False Lumen ◽  
Preoperative Imaging ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Artery Involvement ◽  
Postoperative Stroke

Abstract Background Stroke is a common postoperative complication in patients with acute type A aortic dissection (ATAAD). We aimed to explore the preoperative imaging risk findings for postoperative new stroke in patients with ATAAD. Methods From January 2015 to December 2018, 174 patients with ATAAD who underwent preoperative aortic computed tomography angiography (CTA) and cerebral diffusion-weighted imaging (DWI) as well as postoperative brain CT were included, and divided into DWI (+) and DWI (-) groups. Pre- and intraoperative variables were collected, and logistic regression analysis was used to determine the independent risk predictors of postoperative new stroke. Results The incidence of postoperative new stroke was 18.4% (32/174) in patients with ATAAD. Postoperative stroke was detected in 13 (31.0%) patients in the DWI (+) group and in 19 (14.4%) patients in the DWI (-) group with significant difference (P = 0.016). In the DWI (+) group, the lesions of the cerebral infarction located in the unilateral cerebral hemisphere and distributed more than three lobes (P = 0.007) were an independent risk factor for postoperative new stroke. Hypotension (P = 0.002), retrograde ascending aorta dissection with thrombosis of the false lumen (P = 0.010), aortic arch entry (P = 0.035), and coronary artery involvement (P = 0.001) were independent risk factors for postoperative stroke in the DWI (-) cohort. Conclusions Patients with ATAAD with cerebral infarction are more likely to develop postoperative new stroke; thus, a preoperative DWI examination may be necessary. DWI lesions distributed more than 3 lobes in the unilateral hemisphere suggest a high possibility of postoperative stroke. For patients with ATAAD with normal brain, particular attention should be given to the CTA findings of false lumen thrombosis, aortic arch entry, and coronary artery involvement to avoid postoperative stroke. Trial registration: Retrospectively registered.

scholarly journals Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

2020 ◽  
Vol 7 ◽  
Author(s):  
Hongliang Zhao ◽  
Fan Guo ◽  
Jingji Xu ◽  
Yuanqiang Zhu ◽  
Didi Wen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Cerebral Infarction ◽  
Aortic Arch ◽  
False Lumen ◽  
Preoperative Imaging ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Artery Involvement ◽  
Postoperative Stroke

Background: Stroke is a common postoperative complication in patients with acute type A aortic dissection (ATAAD). We aimed to explore the preoperative imaging risk findings for postoperative new stroke in patients with ATAAD.Methods: From January 2015 to December 2018, 174 patients with ATAAD who underwent preoperative aortic computed tomography angiography (CTA) and cerebral diffusion-weighted imaging (DWI) as well as postoperative brain CT were included, and divided into DWI (+) and DWI (–) groups. Pre- and intraoperative variables were collected, and logistic regression analysis was used to determine the independent risk predictors of postoperative new stroke.Results: The incidence of postoperative new stroke was 18.4% (32/174) in patients with ATAAD. Postoperative stroke was detected in 13 (31.0%) patients in the DWI (+) group and in 19 (14.4%) patients in the DWI (–) group with significant difference (P = 0.016). In the DWI (+) group, the lesions of the cerebral infarction located in the unilateral cerebral hemisphere and distributed more than three lobes (P = 0.007) were an independent risk factor for postoperative new stroke. Hypotension (P = 0.002), retrograde ascending aorta dissection with thrombosis of the false lumen (P = 0.010), aortic arch entry (P = 0.035), and coronary artery involvement (P = 0.001) were independent risk factors for postoperative stroke in the DWI (–) cohort.Conclusions: Patients with ATAAD with cerebral infarction are more likely to develop postoperative new stroke; thus, a preoperative DWI examination may be necessary. DWI lesions distributed more than 3 lobes in the unilateral hemisphere suggest a high possibility of postoperative stroke. For patients with ATAAD with normal brain, particular attention should be given to the CTA findings of false lumen thrombosis, aortic arch entry, and coronary artery involvement to avoid postoperative stroke.

scholarly journals The Impact of CK-MB Elevation in Patients With Acute Type A Aortic Dissection With Coronary Artery Involvement

2021 ◽  
Author(s):  
Naoshi Minamidate ◽  
Tomoaki Suzuki
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Statistical Significance ◽  
Artery Bypass ◽  
Type A ◽  
Coronary Perfusion ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Artery Involvement ◽  
The Impact

Abstract Background Acute coronary artery involvement (ACI) is a lethal complication of acute type A aortic dissection. Although ACI has been reported as one of the prognostic factors of acute type A aortic dissection, it does not always cause coronary ischemia. The extent of myocardial damage varies from case to case. Moreover, since the definition of ACI varies from paper to paper, it is unknown what the difference is between ACI with and without myocardial necrosis. In general, it can be assumed that cases with myocardial infarction have worse results. However, it is unknown how poor ACI is with myocardiac ischemia and how optimistic it is without it. This study compared the surgical results between the two groups of ACI with or without myocardiac ischemia. Methods Among 348 patients who underwent an emergency operation for acute type A aortic dissection, there were 28 (8.0%) patients complicated by ACI and underwent additional coronary artery bypass grafting. We divided 26 of those patients into two groups; the MI group ( with CK-MB elevation) and the NMI group (without CK-MB elevation) and compared both groups. Results Of the 26, sixteen were in the MI group, and ten were in the NMI group. The average CK-MB in the MI group was 225.5 IU/L, and that in the NMI group was 13.5 IU/L. The mean time from onset to surgery was 248 minutes in the MI group, 250 minutes in the NMI group. There was statistical significance in mortality ( 69% vs. 13%, p=0.03). There was no significance in major complications (ICU days, reintubation, reoperation, pneumonia, sepsis). Conclusions Acute coronary artery involvement was associated with 8.0% of patients with ATAAD, and 62% of them had myocardial ischemia with CK-MB elevation. As expected, the MI group had significantly higher mortality than the NMI group. It is crucial for cases with suspected ACI to obtain coronary perfusion as soon as possible to prevent CK-MB from elevationg.

scholarly journals Long-Term Outcomes of Surgical Treatment for Acute Type-A Aortic Dissection with Coronary Artery Involvement

2021 ◽  
Vol 62 (5) ◽  
pp. 1069-1075
Author(s):  
Shuyang Lu ◽  
Yun Zhao ◽  
Kai Song ◽  
Wangchao Yao ◽  
Le Kang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Long Term Outcomes ◽  
Type A Aortic Dissection ◽  
Coronary Artery Involvement

Repair of acute type A dissection with distal malperfusion using a novel hybrid arch device

2020 ◽  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Acute Type A Dissection ◽  
Feasible Option

Acute type A aortic dissection remains a high-risk surgical condition, and mortality among those presenting with malperfusion is up to 3-fold higher. Despite the added technical challenge of distal aortic arch interventions in the acute setting, it may be necessary to resolve distal malperfusion in patients with this disorder. The ideal arch intervention to address acute type A aortic dissection complicated by malperfusion should address the following objectives: (1) to relieve distal malperfusion by expanding the distal true lumen and depressurizing the false lumen; (2) to avoid compromising arch branches without requiring additional arch branch interventions; (3) to minimize the risk of spinal cord ischemia; and (4) to minimize the operative duration and circulatory arrest time. The use of an uncovered aortic arch stent that is delivered in an antegrade manner during circulatory arrest, concomitantly with hemiarch replacement, therefore represents an attractive solution in the management of acute type A aortic dissection complicated by malperfusion. This strategy does not require complex arch reconstruction and may thus be a feasible option among cardiac and vascular surgeons in lower volume aortic centers. Here we present a step-by-step approach to acute type A aortic dissection repair with hemiarch repair and delivery of an uncovered arch stent for a patient presenting with malperfusion.

Acute Type-A Aortic Dissection with Obstruction of the Right Coronary Artery

2014 ◽  
Vol 17 (4) ◽  
pp. 196
Author(s):  
Erhan Kaya ◽  
Halit Yerebakan ◽  
Daniel Spielman ◽  
Omer Isik ◽  
Cevat Yakut
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Right Coronary Artery ◽  
Type A ◽  
Sudden Onset ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Syndrome ◽  
Bentall Procedure ◽  
The Right

Occlusion of a coronary artery by an acute type A aortic dissection presents a life-threatening emergency that is rarely seen and easy to misdiagnose. We present the case of a 75-year-old male who experienced sudden onset of severe left-sided chest pain due to an acute type A aortic dissection that obstructed the right coronary artery. Following an initial misdiagnosis of acute coronary syndrome, imaging revealed the presence of an aortic dissection. An emergency modified Bentall procedure was performed, in which the damaged aorta and aortic valve were replaced.

Initial Management of Acute Type-A Aortic Dissection with a Thrombosed False Lumen: A Retrospective Cohort Study

Surgery Today ◽  
2004 ◽  
Vol 34 (8) ◽  
Author(s):  
Yoshihiko Kurimoto ◽  
Kiyofumi Morishita ◽  
Nobuyoshi Kawaharada ◽  
Johji Fukada ◽  
Yasufumi Asai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Aortic Dissection ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Initial Management ◽  
Type A Aortic Dissection

Do oral anticoagulants impact outcomes and false lumen patency after repair of acute type A aortic dissection?

2021 ◽  
Author(s):  
Igor Vendramin ◽  
Daniela Piani ◽  
Andrea Lechiancole ◽  
Nunzio Davide de Manna ◽  
Sandro Sponga ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Oral Anticoagulants ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

Intraoperative angiography for visceral arteries originating from false lumen

2021 ◽  
pp. 021849232110414
Author(s):  
Shintaro Takago ◽  
Satoru Nishida ◽  
Yukihiro Noda ◽  
Yu Nosaka ◽  
Ryo Yamamura ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
False Lumen ◽  
External Iliac Artery ◽  
Acute Type ◽  
Elephant Trunk ◽  
Intraoperative Angiography ◽  
Visceral Arteries ◽  
Enhanced Computed Tomography

A 70-year-old man had an acute type B aortic dissection 9 years before his admission. The last enhanced computed tomography that was performed revealed an aneurysm that extended from the ascending aorta to the aortic arch, associated with a chronic aortic dissection, which extended from the aortic arch to the left external iliac artery. His visceral arteries originated from the false lumen. We performed a total arch replacement with a frozen elephant trunk in the hybrid operating room. Immediately after the circulatory arrest termination, using intraoperative angiography, we verified that the blood supply to the visceral arteries was patent.

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