Cerebrovascular imaging of cerebral ischemia in acute type A aortic dissection

Matsubara, Soichiro; Koga, Masatoshi; Ohara, Tomoyuki; Iguchi, Yasuyuki; Minatoya, Kenji; Terada, Yoshio; Fukuda, Tsuyoshi; Miyazaki, Yuichi; Kajimoto, Kan; Sakamoto, Yuki; Makita, Naoki; Tokuda, Naoki; Nagatsuka, Kazuyuki; Ando, Yumiko; Toyoda, Kazunori

doi:10.1016/j.jns.2018.02.044

Cited by 8 publications

(7 citation statements)

References 31 publications

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“…A comparison between 17 consecutive patients admitted to NCVC for ischemic stroke/TIA as a complication of ATAAD who underwent MRI/MRA between January 2009 and December 2015 and 249 consecutive patients admitted to NCVC for ischemic stroke/TIA without ATAAD who underwent MRI/MRA between January 2013 and December 2013, showed that ATAAD patients had infarcts more frequently in the right anterior cerebral artery (ACA) territory (18 vs. 2%, p = 0.007) and the right middle cerebral artery (MCA) territory (71 vs. 29%, p < 0.001) [29]. On the MRA image, the ATAAD patients more frequently had poor visualization of the right internal carotid artery (ICA) (47 vs. 6%, p < 0.001).…”

Section: Clinical Characteristics Of Ischemic Stroke As a Complicatiomentioning

confidence: 99%

Acute ischemic stroke as a complication of Stanford type A acute aortic dissection: a review and proposed clinical recommendations for urgent diagnosis

Koga

Iguchi

Ohara

et al. 2018

Gen Thorac Cardiovasc Surg

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When treating any suspected stroke patients, emergency services and initial urgent care doctors should always suspect aortic dissection. Even in the absence of chest or back pain, the initial urgent care doctor needs to immediately perform chest contrast CT if suspecting aortic dissection from blood pressure laterality or upper mediastinal widening on chest X-ray. Whenever aortic dissection cannot be ruled out from initial clinical information, the initial urgent care doctor should evaluate the common carotid artery (CCA). Dissection extension to the CCA or flow abnormality of the CCA is often detected if aortic dissection is a cause of ischemic stroke or transient ischemic attack. Head CT or MRI including vascular imaging is preferable. D-dimer should be measured in hospitals where available. As soon as aortic dissection is identified, the initial urgent care doctor needs to consult with cardiovascular surgeons or cardiologists for appropriate treatment.

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Section: Clinical Characteristics Of Ischemic Stroke As a Complicatiomentioning

confidence: 99%

Acute ischemic stroke as a complication of Stanford type A acute aortic dissection: a review and proposed clinical recommendations for urgent diagnosis

Koga

Iguchi

Ohara

et al. 2018

Gen Thorac Cardiovasc Surg

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“…Our results revealed that the BFV of the bilateral ICA and right VA was obviously reduced in AAD patients with affected arch branches, and the proportions of abnormal spectral waveforms, such as the low‐resistance waveform and steal phenomenon, were significantly increased in the affected group. Furthermore, our data showed that the most frequently affected vessels were the INA (50.0%) and RCCA (39.1%) (Figure 2), which explained the poor visualization of the right ICA, ACA and MCA on MRI 27 . All these data may suggest that a more aggressive strategy of arch replacement should be performed when carotid artery Doppler flow is restricted.…”

Section: Discussionmentioning

confidence: 78%

“…Some researchers have begun to focus on CCA dissection in AAD patients 25,26 . Ohara T et al reported a high rate of ischemic stroke among AAD patients (23/226, 10%) 5 and revealed ischemic stroke/TIA to be a complication of AAD in 17 consecutive patients who underwent head MRI/MRA, which exhibited poor visualization of the right ICA, anterior cerebral artery (ACA) and middle cerebral artery (MCA) 27 . These results indicated the presence of decreased cerebral blood flow‐induced AIS/TIA in the AAD patients.…”

Section: Discussionmentioning

confidence: 99%

Cerebral infarction and risk factors in acute type A aortic dissection with arch branch extension

et al. 2022

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Objective: Stanford type A aortic dissection (AAD) may affect the supra-aortic arteries, which are associated with acute ischemic stroke (AIS) or transient ischemic attack (TIA). This study aimed to investigate cerebral perfusion, the infarction incidence and risk factors in AAD patients.Methods: A total of 156 consecutive AAD patients were enrolled and divided into two groups according to whether the aortic arch branches were involved: the affected group (n = 90) and the unaffected group (n = 66). Clinical, echocardiographic/carotid Doppler data and cerebral infarction morbidity were compared between the groups. Independent predictors of 30-day AAD mortality were identified through multivariable Cox regression, and perioperative risk factors were analyzed. Results:In total, 57.7% of AAD patients had aortic arch branch involvement. Abnormal Doppler waveforms were more common in the affected group (p < 0.05). Regarding intracranial perfusion, the blood flow volumes (BFVs) of the bilateral internal carotid arteries (ICAs) and right vertebral artery (RVA) in the affected group were significantly reduced (p < 0.05). The incidence of cerebral infarction in the affected group was significantly higher than that in the unaffected group (35.6% vs. 19.7%, p = 0.031). Multivariable analysis revealed that age >45 years old, right internal carotid artery (RICA) involvement and reduced left ventricular ejection fraction (LVEF) were significant predictors of perioperative death.Conclusions: Aortic arch branch involvement is common in patients with AAD and is associated with reduced cerebral blood flow (especially on the right side) and a higher incidence of cerebral infarction. Age, extension of the RICA dissection and LVEF impairment are independent risk factors for AAD-related death.

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“…Poor visualization of the right internal common carotid artery is secondary to common carotid artery dissection, and cerebral severe hypoperfusion of the right hemisphere is shown by magnetic resonance imaging perfusion-weighted imaging. 4 The main neurological complications of aortic dissection are as follows: (i) major neurological deficit (coma or ischemic stroke), (ii) transient ischemic attack (TIA), (iii) spinal cord ischemia (paraparesis, paraplegia), (iv) ischemic neuropathy, and (v) hypoxic-ischemic encephalopathy. Among them, ischemic stroke is reported as the most frequent complication because it affects up to one third of patients with aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of aortic dissection with sudden coma and paraplegia as the main symptoms

et al. 2020

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Objective: This study aimed to investigate the clinical characteristics of patients with aortic dissection presenting with neurological symptoms as the initial symptoms. Methods: Clinical characteristics, radiological abnormalities, and prognosis were analyzed in two female patients with aortic dissection. The main clinical symptoms were sudden coma and paraplegia. A detailed clinical examination was performed and computed tomography scans were evaluated. Results: The initial symptoms of the patients involved the nervous system. Chest and abdominal computed tomography scans were performed to confirm the diagnosis of aortic dissection. Both patients died. Conclusion: Patients who present with nervous system symptoms as the first symptoms of aortic dissection, which lead to misdiagnosis and missing the diagnosis, are rare. Improvement in the understanding of this disease is required to ensure that patients receive a timely diagnosis in the early stages.

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Cerebrovascular imaging of cerebral ischemia in acute type A aortic dissection

Cited by 8 publications

References 31 publications

Acute ischemic stroke as a complication of Stanford type A acute aortic dissection: a review and proposed clinical recommendations for urgent diagnosis

Acute ischemic stroke as a complication of Stanford type A acute aortic dissection: a review and proposed clinical recommendations for urgent diagnosis

Cerebral infarction and risk factors in acute type A aortic dissection with arch branch extension

Clinical analysis of aortic dissection with sudden coma and paraplegia as the main symptoms

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