Type A Aortic Dissection With Cerebral Malperfusion: New Insights.

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Type A aortic dissection with cerebral malperfusion presents significant surgical challenges.
• Craniocervical vessel involvement is critical but under-investigated in surgical literature.

Purpose of the Study:

• To investigate the impact of craniocervical vessel involvement on outcomes in patients with type A aortic dissection and cerebral malperfusion.

Main Methods:

• Retrospective review of medical records and imaging studies for 775 patients with acute type A aortic dissection between 1997 and 2019.
• Analysis of 80 patients (10%) presenting with cerebral malperfusion, focusing on cerebrocervical imaging findings and management strategies.

Main Results:

• Internal carotid artery (ICA) occlusion was present in 24% of patients with available imaging, associated with 100% mortality due to cerebral edema and herniation.
• Common carotid artery (CCA) occlusion without ICA involvement occurred in 62% and had a 79% survival rate to discharge with significantly fewer neurologic deaths.
• In-hospital mortality for all patients was 40%, with 81.3% of deaths being neurology-related.

Conclusions:

• ICA occlusion in type A aortic dissection may predict poor neurologic outcomes irrespective of surgical approach.
• CCA occlusion or coma should not deter surgical candidacy for type A aortic dissection.
• Prompt neck CT angiography is advisable for patients with cerebral malperfusion due to aortic dissection.