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The Guidance of Head-Neck-Aorta CT Angiography in Acute Type A Aortic Dissection Patients

Hongliang Zhao1, Chengxiang Li2, Jian Xu1

  • 1Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.

JACC. Asia
|May 8, 2025
PubMed

Insights

Preoperative extended head-neck-aorta CTA in acute type A aortic dissection (ATAAD) surgery improved neurological outcomes. This imaging approach identified critical carotid artery issues, leading to modified surgical strategies and reduced permanent neurological deficits.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Radiology

Background:

  • The diagnostic value of preoperative craniocervical artery imaging for acute type A aortic dissection (ATAAD) surgical repair remains unclear.
  • Optimal surgical decision-making in ATAAD may benefit from detailed anatomical information of the head and neck vasculature.

Purpose of the Study:

  • To investigate the clinical significance of preoperative extended head-neck-aorta computed tomography angiography (CTA) in patients with ATAAD.
  • To evaluate the impact of extended CTA on neurological outcomes following ATAAD surgical repair.

Main Methods:

  • A retrospective analysis of ATAAD patients undergoing surgical repair was conducted.
  • Patients were divided into conventional aortic CTA (215) and extended CTA (220) groups.
  • A 1:1 propensity score matching analysis created 154 pairs to compare outcomes, with the primary endpoint being postoperative neurological deficits.

Main Results:

  • The extended CTA group revealed significant common carotid artery stenosis or occlusion in 35% of asymptomatic patients.
  • The extended CTA group more frequently utilized common carotid artery reconstruction and bilateral antegrade selective cerebral perfusion.
  • In the matched cohort, extended CTA was significantly associated with fewer postoperative permanent neurological deficits (aOR: 0.186; P = 0.004).

Conclusions:

  • Extended head-neck-aorta CTA provides crucial preoperative anatomical detail for ATAAD surgical planning.
  • This enhanced imaging protocol facilitates modified surgical strategies, potentially improving neurological outcomes in ATAAD patients.
Abstract

Keywords:
aortic dissectionaortic surgerycerebral protectioncomputed tomography angiography (CTA)craniocervical arterypostoperative neurological deficit

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