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Carotid artery dissection and neurological complications after surgery for type 1 aortic dissection

Fausto Biancari1, Timo Mäkikallio2, Stefano Rosato3

  • 1Department of Cardiovascular Surgery, Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy faustobiancari@yahoo.it.

Open Heart
|March 13, 2025
PubMed

Insights

Bilateral common carotid artery dissection in type A aortic dissection surgery increases risks for neurological complications and in-hospital mortality. Unilateral dissection does not appear to significantly impact outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Surgery

Background:

  • Prognostic data regarding type A aortic dissection involving common carotid arteries (CCAs) are limited.
  • Understanding the impact of CCA involvement is crucial for surgical planning and patient outcomes.

Purpose of the Study:

  • To investigate the prognostic significance of common carotid artery (CCA) dissection in patients undergoing surgery for DeBakey type 1 aortic dissection.
  • To evaluate the association between CCA dissection and postoperative neurological complications and in-hospital mortality.

Main Methods:

  • Retrospective analysis of 1106 patients from the European Registry for Thoracic Aortic Aneurysm and Dissection (ERTAAD) database.
  • Data included surgical status of CCAs, neurological complications (stroke, global brain ischemia), and in-hospital mortality.
  • Statistical analysis compared outcomes based on the absence, unilateral, or bilateral involvement of CCAs.

Main Results:

  • Bilateral CCA dissection was associated with significantly higher in-hospital mortality (27.3%) compared to no dissection (19.5%) or unilateral dissection (16.9%).
  • Bilateral CCA dissection increased the risk of neurological complications (40.0% vs 18.9% without dissection).
  • The negative prognostic impact of bilateral CCA dissection was more pronounced in patients without cerebral malperfusion undergoing hypothermic circulatory arrest.

Conclusions:

  • Bilateral, but not unilateral, common carotid artery dissection is linked to increased risks of neurological complications and in-hospital mortality after surgery for DeBakey type 1 aortic dissection.
  • These findings highlight the importance of assessing CCA status in aortic dissection management.
Abstract

Keywords:
Aneurysm, DissectingCardiac Surgical ProceduresCarotid Artery DiseasesSTROKE

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