Cerebral perfusion issues in type A aortic dissection

Pacini, Davide; Murana, Giacomo; Marco, Luca Di; Berardi, Marianna; Mariani, Carlo; Coppola, Giuditta; Fiorentino, Mariafrancesca; Leone, Alessandro; Bartolomeo, Roberto Di

doi:10.21037/jovs.2018.03.20

Cited by 23 publications

(25 citation statements)

References 30 publications

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“…Evaluation of preoperative risk factors for postoperative stroke based on imaging information is also accurate. In this study, preoperative acute cerebral infarction resulting from cerebral hypoperfusion is frequent and is found in 24.1% of the brains, which is higher than the results in previous studies (17)(18)(19). This may be related to the fact that the majority of the patients with ATAAD in this study had neurological symptoms and signs.…”

Section: Discussioncontrasting

confidence: 67%

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

Zhao

Guo

et al. 2020

Front. Cardiovasc. Med.

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Background: Stroke is a common postoperative complication in patients with acute type A aortic dissection (ATAAD). We aimed to explore the preoperative imaging risk findings for postoperative new stroke in patients with ATAAD.Methods: From January 2015 to December 2018, 174 patients with ATAAD who underwent preoperative aortic computed tomography angiography (CTA) and cerebral diffusion-weighted imaging (DWI) as well as postoperative brain CT were included, and divided into DWI (+) and DWI (–) groups. Pre- and intraoperative variables were collected, and logistic regression analysis was used to determine the independent risk predictors of postoperative new stroke.Results: The incidence of postoperative new stroke was 18.4% (32/174) in patients with ATAAD. Postoperative stroke was detected in 13 (31.0%) patients in the DWI (+) group and in 19 (14.4%) patients in the DWI (–) group with significant difference (P = 0.016). In the DWI (+) group, the lesions of the cerebral infarction located in the unilateral cerebral hemisphere and distributed more than three lobes (P = 0.007) were an independent risk factor for postoperative new stroke. Hypotension (P = 0.002), retrograde ascending aorta dissection with thrombosis of the false lumen (P = 0.010), aortic arch entry (P = 0.035), and coronary artery involvement (P = 0.001) were independent risk factors for postoperative stroke in the DWI (–) cohort.Conclusions: Patients with ATAAD with cerebral infarction are more likely to develop postoperative new stroke; thus, a preoperative DWI examination may be necessary. DWI lesions distributed more than 3 lobes in the unilateral hemisphere suggest a high possibility of postoperative stroke. For patients with ATAAD with normal brain, particular attention should be given to the CTA findings of false lumen thrombosis, aortic arch entry, and coronary artery involvement to avoid postoperative stroke.

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Section: Discussioncontrasting

confidence: 67%

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

Zhao

Guo

et al. 2020

Front. Cardiovasc. Med.

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show abstract

“…In this study, preoperative acute cerebral infarction resulting from cerebral hypoperfusion is frequent and is found in 24.1% of the brains, which is higher than the results in previous studies. [17][18][19] This may be related to the fact that the majority of the patients with ATAAD in this study had neurological symptoms and signs. Our results, showing a percentage of 18.4% of postoperative stroke in patients with ATAAD, are similar to those reported in a previous study.…”

Section: Discussionmentioning

confidence: 86%

Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

Zhao

Guo

et al. 2020

Preprint

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Background Stroke is a common postoperative complication in patients with acute type A aortic dissection (ATAAD). We aimed to explore the preoperative imaging risk findings for postoperative new stroke in patients with ATAAD. Methods From January 2015 to December 2018, 174 patients with ATAAD who underwent preoperative aortic computed tomography angiography (CTA) and cerebral diffusion-weighted imaging (DWI) as well as postoperative brain CT were included, and divided into DWI (+) and DWI (-) groups. Pre- and intraoperative variables were collected, and logistic regression analysis was used to determine the independent risk predictors of postoperative new stroke. Results The incidence of postoperative new stroke was 18.4% (32/174) in patients with ATAAD. Postoperative stroke was detected in 13 (31.0%) patients in the DWI (+) group and in 19 (14.4%) patients in the DWI (-) group with significant difference (P = 0.016). In the DWI (+) group, the lesions of the cerebral infarction located in the unilateral cerebral hemisphere and distributed more than three lobes (P = 0.007) were an independent risk factor for postoperative new stroke. Hypotension (P = 0.002), retrograde ascending aorta dissection with thrombosis of the false lumen (P = 0.010), aortic arch entry (P = 0.035), and coronary artery involvement (P = 0.001) were independent risk factors for postoperative stroke in the DWI (-) cohort. Conclusions Patients with ATAAD with cerebral infarction are more likely to develop postoperative new stroke; thus, a preoperative DWI examination may be necessary. DWI lesions distributed more than 3 lobes in the unilateral hemisphere suggest a high possibility of postoperative stroke. For patients with ATAAD with normal brain, particular attention should be given to the CTA findings of false lumen thrombosis, aortic arch entry, and coronary artery involvement to avoid postoperative stroke. Trial registration: Retrospectively registered.

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“…Unfortunately, we still do not have any definitive evidence that a specific surgical strategy or perfusion technique could ameliorate the prognosis of the patients. 10…”

Section: Discussionmentioning

confidence: 99%

Generalized convulsive status epilepticus after retrograde type A aortic dissection surgery

Shi

et al. 2020

Perfusion

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Introduction: Generalized convulsive status epilepticus is defined as a generalized and convulsive seizure with 5 minutes or more of continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery between seizures. For the first time, we present a case with retrograde type A aortic dissection after endovascular repairment and received thoracotomy intensely. Case report: The patient experienced frequent generalized seizures in the immediate postoperative period, and status epilepticus was considered for his medical history, clinic symptoms and related examinations. Discussion and Conclusion: Generalized convulsive status epilepticus should be alert for avoiding delay in the rehabilitation particularly after aortic dissection surgery. Under the good condition of ventilation, combining morphine with midazolam or diazepam can more effectively relieve the symptoms.

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Cerebral perfusion issues in type A aortic dissection

Cited by 23 publications

References 30 publications

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

Generalized convulsive status epilepticus after retrograde type A aortic dissection surgery

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