Neurological Complications Associated with Acute Aortic Dissection: Is There a Place for a Surgical Approach?

Abstract

In a series of 187 consecutive patients sustaining aortic dissection during a 15-year period, 144 had an acute dissection of type A, whereas 43 patients suffered from other types of aortic dissection (type B). 13 patients with acute aortic A dissection and 3 patients with acute aortic B dissection developed neurological symptoms preoperatively. 11 patients presented diminished or absent carotid pulse and various cerebral symptomatology, 1 had transient ischemic attack and normal carotid pulse. 4 patients had paresis or paralysis of the lower extremity. Three patients died without operation and one other patient died in the immediate post-operative period due to the brain pathology. Four patients presented with persistent or improved hemiplegia or paraplegia after operative repair, one patient showed increase of the neurological symptomatology and 7 patients showed rapid improvement of the symptomatology after repair of the thoracic aorta and had resolution of their neurological deficit; they were evaluated between 2 and 8 years postoperatively and were in a very satisfactory general condition. Preoperative stroke is known to be a predictor of late mortality after ascending aortic dissection. However, its presence should constitute only a relative contraindication to operation because full neurological recovery after thoracic aortic repair and satisfactory long term outcome are possible.

Stroke and Outcomes in Patients With Acute Type A Aortic Dissection

“…Several small studies have since corroborated the feasibility and safety of early surgical repair in TAAAD patients with stroke. 9,13,16,23,24 In fact, 1 study suggested no benefit of surgery beyond 12 hours when cerebral damage is almost complete. 16 Deeb et al 25 have suggested good results with a hybrid approach involving fenestrations for immediate percutaneous reperfusion followed by surgery after the brain tissue has healed.…”

Two different cases of postoperative symptomatic common carotid artery involvment in type A aortic dissection

“…Neurological deficits occur in about 5–15% of patients with type A dissection 3. In a case series, fast replacement of the aortic branch has been recommended for type A dissection because the redirected blood flow into the true aortic lumen helps to restore cerebral perfusion.…”

Urgent simultaneous revascularization of the carotid artery and ascending aortic replacement for type A acute aortic dissection with cerebral malperfusion

“…In contrast, there was no thrombus in the true lumen hemiplegia is more common. [2][3][4] In this case, intermittent left-side paralysis occurred because of malperfusion of the right carotid artery.…”

“…[1][2][3][4] Thus, some have reported that operative treatment is relatively contraindicated. [1][2][3][4] In our case, the right carotid artery was completely occluded, and the right brain was jeopardized. Furthermore, blood fl ow in the right cerebral hemisphere was supplied collaterally from the left carotid and vertebral arteries.…”