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Brachiocephalic artery dissection is a marker of stroke after acute type A aortic dissection repair
Tomoki Cho1, Keiji Uchida1, Keiichiro Kasama1
1Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
Insights
Dissection of the brachiocephalic artery (BCA) significantly increases stroke risk after acute type A aortic dissection (ATAAD) repair. This finding highlights BCA dissection as a key factor to consider in preventing postoperative stroke in ATAAD patients.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Postoperative stroke is a critical complication following acute type A aortic dissection (ATAAD) repair.
- Identifying risk factors for stroke is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence and risk factors of stroke after ATAAD repair.
- To investigate the hypothesis that dissection of supra-aortic vessels is a significant risk factor for stroke.
Main Methods:
- Retrospective analysis of 202 patients who underwent surgical repair for ATAAD between 2012 and 2019.
- Evaluation of clinical data, imaging findings, circulatory support methods, and repair techniques.
- Statistical analysis to identify risk factors associated with postoperative stroke.
Main Results:
- The incidence of postoperative stroke was 12% (25 out of 202 patients).
- Brachiocephalic artery (BCA) dissection was identified as an independent risk factor for stroke (OR, 3.89; p=.035).
- No significant association was found between stroke and preoperative malperfusion, circulatory arrest time, cerebral perfusion time, repair technique, or femoral artery perfusion.
Conclusions:
- Dissection of the brachiocephalic artery is an independent risk factor for stroke after ATAAD repair.
- These findings emphasize the importance of assessing BCA involvement in ATAAD patients to mitigate stroke risk.
Objective:
Postoperative stroke is a serious unsolved complication after acute type A aortic dissection (ATAAD) repair. We investigated the incidence and risk factors of stroke, and hypothesized that dissection of supra-aortic vessels is an important risk factor of this morbidity.
Methods:
Between 2012 and 2019, 202 (56% men, median age 68 years) patients with ATAAD underwent surgical repair. Clinical data, image findings, method of circulatory support, and repair technique were retrospectively investigated to explore the risk factor of postoperative stroke.
Results:
Of the 202 patients, operative mortality was 6% and the incidence of postoperative stroke was 12% (n = 25). Brachiocephalic artery (BCA) dissection was associated with a higher risk of stroke (odds ratio, 3.89; 95% confidence interval, 1.104-13.780; p = .035) having no relation to the presence or absence of left common carotid artery dissection. Preoperative malperfusion syndrome, circulatory arrest time, isolated cerebral perfusion time, repair technique (total arch replacement), and femoral artery perfusion alone were not related to the incident rate of postoperative stroke. Stroke occurred in both hemispheres, regardless of the laterality of carotid artery dissection.
Conclusion:
BCA dissection was an independent risk factor of stroke after ATAAD repair.
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