Type A aortic dissection: involvement of carotid artery and impact on cerebral malperfusion

Munir, Wahaj; Harky, Amer; Bashir, Mohamad; Adams, Benjamin

doi:10.1177/0218492320984329

Cited by 8 publications

(8 citation statements)

References 52 publications

(78 reference statements)

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“… 2 TAAD is a surgical emergency and its management has the complexity and poor outcomes when there is organ malperfusion. 3 …”

Section: Introductionmentioning

confidence: 99%

Patterns of Immune Infiltration and the Key Immune-Related Genes in Acute Type A Aortic Dissection in Bioinformatics Analyses

Chen¹,

Han²,

Tang³

2021

IJGM

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Background Immune-inflammatory mechanisms contribute greatly to the complex process leading to type A aortic dissection (TAAD). This study aims to explore immune infiltration and key immune-related genes in acute TAAD. Methods ImmuCellAI algorithm was applied to analyze patterns of immune infiltration in TAAD samples and normal aortic vessel samples in the GSE153434 dataset. Differentially expressed genes (DEGs) were screened. Immune-related genes were obtained from overlapping DEGs of GSE153434 and immune genes of the ImmPort database. The hub genes were obtained based on the protein–protein interaction (PPI) network. The hub genes in TAAD were validated in the GSE52093 dataset. The correlation between the key immune-related genes and infiltrating immune cells was further analyzed. Results In the study, the abundance of macrophages, neutrophils, natural killer T cells (NKT cells), natural regulatory T cells (nTreg), T-helper 17 cells (Th17 cells) and monocytes was increased in TAAD samples, whereas that of dendritic cells (DCs), CD4 T cells, central memory T cells (Tcm), mucosa associated invariant T cells (MAIT cells) and B cells was decreased. Interleukin 6 (IL-6), C-C motif chemokine ligand 2 (CCL2) and hepatocyte growth factor (HGF) were identified and validated in the GSE52093 dataset as the key immune-related genes. Furthermore, IL-6, CCL2 and HGF were correlated with different types of immune cells. Conclusion In conclusion, several immune cells such as macrophages, neutrophils, NKT cells, and nTreg may be involved in the development of TAAD. IL-6, CCL2 and HGF were identified and validated as the key immune-related genes of TAAD via bioinformatics analyses. The key immune cells and immune-related genes have the potential to be developed as targets of prevention and immunotherapy for patients with TAAD.

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“… 2 TAAD is a surgical emergency and its management has the complexity and poor outcomes when there is organ malperfusion. 3 …”

Section: Introductionmentioning

confidence: 99%

Patterns of Immune Infiltration and the Key Immune-Related Genes in Acute Type A Aortic Dissection in Bioinformatics Analyses

Chen¹,

Han²,

Tang³

2021

IJGM

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Section: Exploring the Natural History: The Missed Elementsmentioning

confidence: 99%

“…9 The concomitant events of carotid and cerebral malperfusion carry the burden of a worse prognosis, not only due to poorer clinical conditions of the patients but due to the heightened risk of misdiagnosis. 8,10 Harris et al 31 reported from their analysis of data from IRAD that those patients who had undergone previous cardiac surgery, were transferred from nontertiary centers of non-White race, or female had significantly greater time taken from the presentation to diagnosis.…”

Section: Family History and Prognosismentioning

confidence: 99%

“…9 The concomitant events of carotid and cerebral malperfusion worsen the prognosis not only due to poorer clinical conditions of the patients, but also because of the heightened risk of misdiagnosis. 8 10 Any tool to support the efficacy of the decision-making and rapid risk stratification for intervention is invaluable. Stratifying the risk of adverse outcomes postdissection will guide the surgeon toward the optimum therapeutic choice.…”

Section: The Need For Risk Modelsmentioning

confidence: 99%

See 1 more Smart Citation

Risk Prediction Models for Management of Patients following Acute Aortic Dissection

Munir

Bashir²,

Idhrees³

et al. 2022

Aorta (Stamford)

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Risk prediction of adverse outcomes post aortic dissection is dependet not only on the postdissection-associated clinical factors but on the very foundation of the risk factors that lead up to the dissection itself. There are various such risk factors existing prior to the dissection which impact the postdissection outcomes. In this paper, we review the literature to critically analyze various risk models, burdened by their significant limitations, that attempt to stratify risk prediction based on postdissection patient characteristics. We further review several studies across the literature that investigate the diverse set of predissection risk factors impacting postdissection outcomes. We have discussed and appraised numerous studies which attempt to develop a tool to stratify risk prediction by incorporating the impacts of different factors: malperfusion, blood biochemistry, and perioperative outcomes. The well-validated Penn classification has clearly demonstrated in the literature the significant impact that malperfusion has on adverse outcomes postdissection. Other risk models, already severely hindered by their limitations, lack such validation. We further discuss additional alluded risk factors, including the impact of predissection aortic size, the syndromic and nonsyndromic natures of dissection, and the effects of family history and genetics, which collectively contribute to the risk of adverse outcomes postdissection and prognosis. To achieve the goal of a true risk model, there remains the vital need for appreciation and appropriate consideration for all such aforementioned factors, from before and after the dissection, as discussed in this paper. By being able to incorporate the value of true risk prediction for a patient into the decision-making framework, it will allow a new page of precision medical decision-making to be written.

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“…Extension of dissection to the common carotid arteries (CCA) has an incidence of 30%. It is associated with a significant increase in preoperative neurological deficits (23%, compared to 3% without extension) [ 9 , 10 ]. The right CCA is most frequently affected, in conjunction with the brachiocephalic artery [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review

Aita

Agripnidis

Testud

et al. 2022

JPM

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In this study, we report our local experience of type A aortic dissections in patients with cerebral malperfusion treated with carotid stenting before or after aortic surgery, and present a systematic literature review on these patients treated either with carotid stenting (CS) before or after aortic surgery (AS) or with aortic and carotid surgery alone (ACS). We report on patients treated in our center with carotid stenting for brain hemodynamic injury of carotid origin caused by type A dissection since 2018, and a systematic review was conducted in PubMed for articles published from 1990 to 2021. Out of 5307 articles, 19 articles could be included with a total of 80 patients analyzed: 9 from our center, 29 patients from case reports, and 51 patients from two retrospective cohorts. In total, 8 patients were treated by stenting first, 72 by surgery first, and 7 by stenting after surgery. The mean age; initial NIHSS score; time from symptom onset to treatment; post-treatment clinical improvement; post-treatment clinical worsening; mortality rate; follow-up duration; and follow-up mRS were, respectively, for each group (local cohort, CS before AS, ACS, CS after AS): 71.2 ± 5.3 yo, 65.5 ± 11.0 yo; 65.3 ± 13.1 yo, 68.7 ± 5.8 yo; 4 ± 8.4, 11.3 ± 8.5, 14.3 ± 8.0, 0; 11.8 ± 14.3 h, 21 ± 39.3 h, 13.6 ± 17.8 h, 13 ± 17.2 h; 56%, 71%, 86%, 57%; 11%, 28%, 0%, 14%; 25%, 12.3%, 14%, 33%; 5.25 ± 2.9 months, 54 months, 6.8 ± 3.8 months, 14 ± 14.4 months; 1 ± 1; 0.25 ± 0.5, 1.3 ± 0.8, 0.68 ± 0.6. Preoperative carotid stenting for hemodynamic cerebral malperfusion by true lumen compression appears to be feasible, and could be effective and safe, although there is still a lack of evidence due to the absence of comparative statistical analysis. The literature, albeit growing, is still limited, and prospective comparative studies are needed.

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Type A aortic dissection: involvement of carotid artery and impact on cerebral malperfusion

Cited by 8 publications

References 52 publications

Patterns of Immune Infiltration and the Key Immune-Related Genes in Acute Type A Aortic Dissection in Bioinformatics Analyses

Patterns of Immune Infiltration and the Key Immune-Related Genes in Acute Type A Aortic Dissection in Bioinformatics Analyses

Risk Prediction Models for Management of Patients following Acute Aortic Dissection

Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review

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