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

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.