Commentary: Stroke after type A aortic dissection repair—A web of risk with no single answer

Abstract

Femoral cannulation and antegrade cerebral perfusion were associated with higher rates of stroke in some cases. As such, an individualized repair strategy based on aortic pathology is still required.

Neuroanatomy and severity of stroke in patients with type A aortic dissection

“…Although the modern perioperative mortality rate of acute type A aortic dissection (ATAAD) repair has improved to the 10%-15% range at centers of excellence 1 and evolving surgical strategies have improved the durability of index aortic repair, [2][3][4] the rate of stroke has not changed (>10%) in the past two decades. 5,6 Historically, stroke after ATAAD surgery with deep hypothermic circulatory arrest (DHCA) was thought to be due to hypoperfusion during the circulatory arrest period and time was of the essence. While the introduction of selective cerebral perfusion strategies during arch surgery has decreased the incidence of stroke, it remains a persistent surgical complication.…”