An extensive chronic aortic dissection presenting with acute embolic stroke

Basnet, Sijan; Mainali, Naba Raj; Tharu, Biswaraj; Dhital, Rashmi; Poudel, Dilli Ram

doi:10.1080/20009666.2017.1379854

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…It is more common in males in their seventh decade of life and with a personal history of hypertension [1]. Other risk factors include smoking, obesity, and connective tissue diseases, and there is an agreement among many risk factors for this pathology and ischemic stroke [1,2,5].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ischemic Stroke as a Form of Presentation of Aortic Dissection: A Case Report

Carrillo-Alfonso,

Mugeiro,

Amado

et al. 2024

Cureus

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Aortic dissection is a rare condition with a high mortality rate, the clinical manifestations of which depend on the involvement of aortic branches. We describe the case of a male patient with neurological deficits accompanied by dorsal-lumbar pain and exuberant sympathetic hyperactivity, diagnosed with ascending and descending aorta dissection, initially managed in the prehospital setting. This case reinforces the importance of maintaining high levels of suspicion for rare causes of cerebrovascular accidents.

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Section: Discussionmentioning

confidence: 99%

“…Typically, the onset manifests as severe and abrupt chest, abdominal, or interscapular pain [1,2]. Nevertheless, under specific conditions, aortic dissection can be an uncommon cause of ischemic stroke, and the onset may be marked by new neurological deficits [1,2,5].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke as a Form of Presentation of Aortic Dissection: A Case Report

Carrillo-Alfonso,

Mugeiro,

Amado

et al. 2024

Cureus

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“…Pre-operative acute ischemic stroke (AIS) is one of important factors that affects the outcomes of surgical treatment and long-term post-operative survival in patients with acute type A aortic dissection (ATAAD) ( 1 ). Although ATAAD is a serious aortic disease that requires immediate surgical repair once diagnosed ( 1 , 2 ), The treatment of ATAAD with pre-operative AIS is more challenging. Many studies had proven that neurological damage caused by pre-operative AIS or cerebral malperfusion indicates a poor prognosis following ATAAD ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…Computed tomography angiography (CTA) and transthoracic echocardiography (TTE) have shown high sensitivity in the evaluation of high-risk plaque and vascular anatomy ( 5 ), and thus, are commonly used methods for the diagnosis of aortic dissection ( 6 ). Some studies have suggested about 5–10% of patients with ATAAD had an AIS before surgery, which was caused by the extension of the dissection into the common carotid arteries, thromboembolism or cerebral hypoperfusion ( 2 , 4 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

The Construction of a Risk Prediction Model Based on Neural Network for Pre-operative Acute Ischemic Stroke in Acute Type A Aortic Dissection Patients

Zhao

Zhu

et al. 2021

Front. Neurol.

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Objective: To establish a pre-operative acute ischemic stroke risk (AIS) prediction model using the deep neural network in patients with acute type A aortic dissection (ATAAD).Methods: Between January 2015 and February 2019, 300 ATAAD patients diagnosed by aorta CTA were analyzed retrospectively. Patients were divided into two groups according to the presence or absence of pre-operative AIS. Pre-operative AIS risk prediction models based on different machine learning algorithm was established with clinical, transthoracic echocardiography (TTE) and CTA imaging characteristics as input. The performance of the difference models was evaluated using the receiver operating characteristic (ROC), precision-recall curve (PRC) and decision curve analysis (DCA).Results: Pre-operative AIS was detected in 86 of 300 patients with ATAAD (28.7%). The cohort was split into a training (211, 70% patients) and validation cohort (89, 30% patients) according to stratified sampling strategy. The constructed deep neural network model had the best performance on the discrimination of AIS group compare with other machine learning model, with an accuracy of 0.934 (95% CI: 0.891–0.963), 0.921 (95% CI: 0.845–0.968), sensitivity of 0.934, 0.960, specificity of 0.933, 0.906, and AUC of 0.982 (95% CI: 0.967–0.997), 0.964 (95% CI: 0.932–0.997) in the training and validation cohort, respectively.Conclusion: The established risk prediction model based on the deep neural network method may have the big potential to evaluate the risk of pre-operative AIS in patients with ATAAD.

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Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions

Chung

Chen

Chu

et al. 2022

SVIN

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BACKGROUND Simultaneous multivessel occlusions (MVOs) are a rare condition, which may be encountered during endovascular thrombectomy (EVT) for acute ischemic stroke. This study aimed to investigate the prevalence, associated factors, and outcome of patients with acute ischemic stroke and MVO who underwent EVT. METHODS Consecutive patients with acute ischemic stroke who received EVT between September 2014 and April 2021 were included. Acute MVO was defined as simultaneous occlusions of ≥2 intracranial or extracranial major vessels in either bilateral anterior circulation or anterior plus posterior circulation. Patients’ baseline characteristics and outcome of MVO were analyzed. RESULTS Of 602 patients with acute ischemic stroke (mean age, 71±13 years; male, 53.1%) who received EVT, 11 patients (1.8%) had acute MVO. The involved vessels included bilateral internal carotid arteries in 3, bilateral middle cerebral arteries in 4, vertebral artery and distal middle cerebral artery in 1, and internal carotid artery and distal posterior cerebral artery in 3 patients. Preadmission dependence (modified Rankin scale score >2), higher initial stroke severity, and posterior cerebral artery occlusion were more frequently found in MVO. The cause of MVO included large vessel atherosclerosis in 4, cardioembolic in 4, cancer‐related hypercoagulability in 2, and postpartum in 1 patient. Several patients had received simultaneous multitargeted EVT, but only 4 of them achieved optimal reperfusion in both vessels. Compared with patients without MVO, those with MVO had higher mortality (adjusted odds ratio, 6.75; 95% CI, 1.93–23.6) and poor functional outcome (common odds ratio for 1‐point improvement at modified Rankin scale, 0.14, 95% CI, 0.05–0.45) at 90 days. CONCLUSION Acute simultaneous MVO in patients who underwent EVT is a rare yet devastating condition. Multitarget mechanical thrombectomy to achieve reperfusion is challenging but still possible.

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An extensive chronic aortic dissection presenting with acute embolic stroke

Cited by 3 publications

References 23 publications

Ischemic Stroke as a Form of Presentation of Aortic Dissection: A Case Report

Ischemic Stroke as a Form of Presentation of Aortic Dissection: A Case Report

The Construction of a Risk Prediction Model Based on Neural Network for Pre-operative Acute Ischemic Stroke in Acute Type A Aortic Dissection Patients

Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions

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