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Stroke After Acute Type A Dissection Repair Using Right Axillary Cannulation First Approach.

Suguru Ohira1, Masashi Kai1, Joshua B Goldberg1

  • 1Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.

The Annals of Thoracic Surgery
|December 11, 2023
PubMed
Summary
This summary is machine-generated.

Strokes after acute type A dissection repair (ATAD) predominantly occurred perioperatively, affecting the right anterior circulation regardless of cannulation site. This complication is linked to hemodynamics and innominate artery dissection.

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Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Surgery

Background:

  • Acute type A dissection repair (ATAD) is a complex procedure with potential neurological complications.
  • Understanding stroke mechanisms after ATAD is crucial for improving patient outcomes.
  • The right axillary artery (RAX) first approach is increasingly utilized in ATAD repairs.

Purpose of the Study:

  • To analyze the incidence and characteristics of strokes following acute type A dissection repair (ATAD).
  • To investigate the relationship between arterial cannulation site and stroke occurrence.
  • To elucidate the mechanisms and affected cerebral circulation patterns of perioperative and postoperative strokes.

Main Methods:

  • Retrospective analysis of 356 consecutive ATAD repairs between 2005 and 2022.
  • Categorization of patients based on arterial cannulation site (right axillary artery vs. non-RAX).
  • Evaluation of strokes using head computed tomography and neurological assessments.

Main Results:

  • The overall stroke rate was 8.4%, significantly lower in the RAX group (5.1%) compared to non-RAX (24.2%).
  • Perioperative strokes accounted for 70% of cases, predominantly affecting the right anterior circulation.
  • Mechanisms included hypoperfusion (42.8%) and embolism (33.3%) for perioperative strokes, and embolism (77.8%) for postoperative strokes.

Conclusions:

  • Strokes after ATAD frequently occur perioperatively and impact the right anterior circulation, irrespective of cannulation strategy.
  • Hemodynamic instability and innominate artery (IA) dissection are likely contributors to these strokes.
  • The right axillary artery approach may be associated with a lower stroke rate.