CT-Derived Aortic Plaque Characteristics Predict MRI-Detected Silent Cerebral Infarction after Total Aortic Arch...

Area of Science:

• Cardiovascular Surgery
• Neurology
• Radiology

Background:

• Silent cerebral infarctions are frequent complications following aortic arch surgery.
• The predictive value of preoperative computed tomography (CT)-derived plaque characteristics for these events is not well understood.

Purpose of the Study:

• To investigate the incidence, distribution, and risk factors for new cerebral infarction lesions (NCILs) after total aortic arch replacement (TAR).
• To specifically assess the role of low-attenuation plaque (LAP) burden as a predictor of NCILs.

Main Methods:

• A cohort of 82 consecutive TAR patients was analyzed, with 41 undergoing pre- and postoperative brain MRI.
• Clinical data, CT-derived atheroma grade, plaque attenuation (LAP), and operative details were compared between NCIL-positive and NCIL-negative groups.
• Multivariable analysis included arch atheroma grade and LAP area, adjusted for age and sex.

Main Results:

• NCILs were detected in 61% of patients (25/41), predominantly silent (23/25).
• Patients with NCILs had significantly larger arch LAP area compared to those without (63.9 vs. 17.7 mm²).
• Arch LAP area was the only independent predictor of NCILs (OR 3.01 per 10 mm², p=0.012), while atheroma grade was not significant.

Conclusions:

• Over half of TAR patients develop MRI-detected NCILs, mostly silent.
• Preoperative arch LAP is the sole independent predictor of NCILs after TAR.
• LAP assessment can enhance intraoperative risk stratification and guide neuroprotective strategies.