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Acute Infarcts on Brain MRI Following Aortic Arch Repair With Circulatory Arrest: Insights From the ACE CardioLink-3
Chih-Hao Chen1,2, Mark D Peterson3,4, C David Mazer5,6,7
1Department of Clinical Neurosciences, University of Calgary, AB, Canada (C.-H.C., A.E.B., E.E.S.).
Stroke
|October 31, 2022
Summary
New ischemic brain lesions are common after aortic arch surgery, frequently affecting the middle cerebral artery territory and cerebellum. Risk factors include small vessel disease, lower surgical temperatures, and older age.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Radiology
Background:
- Aortic arch surgery carries a risk of cerebrovascular complications.
- Diffusion-weighted imaging (DWI) is sensitive for detecting acute ischemic lesions.
- Understanding lesion patterns and risk factors is crucial for patient outcomes.
Purpose of the Study:
- To investigate the frequency and distribution of new ischemic brain lesions detected by DWI after aortic arch surgery.
- To identify risk factors associated with the development of these lesions.
Main Methods:
- Secondary analysis of the ACE CardioLink-3 trial comparing innominate vs. axillary artery cannulation.
- Pre- and postoperative brain MRI with DWI was performed on 102 patients.
- New ischemic lesions were defined as new findings on postoperative DWI compared to preoperative scans.
Main Results:
- 70% of patients (71/102) developed new ischemic lesions, averaging 5.5 lesions per affected patient.
- Lesions commonly occurred in the middle cerebral artery territory (50%) and cerebellum.
- Severe preoperative white matter hyperintensity, lower nadir nasopharyngeal temperature, and older age were associated with increased lesion occurrence and number.
Conclusions:
- New ischemic brain lesions are frequent following elective proximal aortic arch surgery.
- The middle cerebral artery territory and cerebellum are commonly affected.
- Underlying small vessel disease, hypothermia during surgery, and advanced age are significant risk factors.
