Extra-anatomic revascularization for preoperative cerebral malperfusion due to distal carotid artery occlusion in acute type A aortic dissection

Luehr, Maximilian; Etz, Christian D.; Nozdrzykowski, Michal; Lehmkuhl, Lukas; Misfeld, Martín; Bakhtiary, Farhad; Borger, Michael A.; Mohr, Friedrich–Wilhelm

doi:10.1093/ejcts/ezv064

Cited by 39 publications

(26 citation statements)

References 13 publications

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“…Previous reports described that preoperative cerebral malperfusion in patients with ATAAD is a predictor for postoperative stroke and detrimental outcome (9)(10)(11). Cerebral malperfusion was diagnosed if patients with ATAAD had neurological symptoms and signs with ultrasonography or radiographic evidence of dissection of the corresponding aortic branch vessel (12). However, a major drawback of this definition is the absence of direct intracranial imaging evidence such as magnetic resonance imaging (MRI) demonstration of diffusion-weighted imaging (DWI) abnormalities.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

Zhao

Guo

et al. 2020

Front. Cardiovasc. Med.

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Background: Stroke is a common postoperative complication in patients with acute type A aortic dissection (ATAAD). We aimed to explore the preoperative imaging risk findings for postoperative new stroke in patients with ATAAD.Methods: From January 2015 to December 2018, 174 patients with ATAAD who underwent preoperative aortic computed tomography angiography (CTA) and cerebral diffusion-weighted imaging (DWI) as well as postoperative brain CT were included, and divided into DWI (+) and DWI (–) groups. Pre- and intraoperative variables were collected, and logistic regression analysis was used to determine the independent risk predictors of postoperative new stroke.Results: The incidence of postoperative new stroke was 18.4% (32/174) in patients with ATAAD. Postoperative stroke was detected in 13 (31.0%) patients in the DWI (+) group and in 19 (14.4%) patients in the DWI (–) group with significant difference (P = 0.016). In the DWI (+) group, the lesions of the cerebral infarction located in the unilateral cerebral hemisphere and distributed more than three lobes (P = 0.007) were an independent risk factor for postoperative new stroke. Hypotension (P = 0.002), retrograde ascending aorta dissection with thrombosis of the false lumen (P = 0.010), aortic arch entry (P = 0.035), and coronary artery involvement (P = 0.001) were independent risk factors for postoperative stroke in the DWI (–) cohort.Conclusions: Patients with ATAAD with cerebral infarction are more likely to develop postoperative new stroke; thus, a preoperative DWI examination may be necessary. DWI lesions distributed more than 3 lobes in the unilateral hemisphere suggest a high possibility of postoperative stroke. For patients with ATAAD with normal brain, particular attention should be given to the CTA findings of false lumen thrombosis, aortic arch entry, and coronary artery involvement to avoid postoperative stroke.

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Section: Introductionmentioning

confidence: 99%

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

Zhao

Guo

et al. 2020

Front. Cardiovasc. Med.

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“…Although the acceptable results of immediate central aortic repair have been reported with routine central aortic repair without any special methods [58–60], a significant number of patients remain disabled, and some have shown an exacerbation and eventual death [59, 61]. Some institutions are attempting carotid artery cannulation either by direct cannulation or by end-to-side graft anastomosis to the carotid artery to quickly and safely restore the blood flow [62–65]. The graft sewn to the carotid artery can be used for aorto-carotid extraanatomical bypass in cases of static obstruction [63, 65].…”

Section: Special Considerations In Cannulation Strategiesmentioning

confidence: 99%

“…Some institutions are attempting carotid artery cannulation either by direct cannulation or by end-to-side graft anastomosis to the carotid artery to quickly and safely restore the blood flow [62–65]. The graft sewn to the carotid artery can be used for aorto-carotid extraanatomical bypass in cases of static obstruction [63, 65]. Good results have been shown.…”

Section: Special Considerations In Cannulation Strategiesmentioning

confidence: 99%

The cannulation strategy in surgery for acute type A dissection

Abe

Usui

2016

Gen Thorac Cardiovasc Surg

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The rates of mortality and morbidity remain high in surgery for acute type A dissection. There is controversy regarding the best cannulation strategy for achieving good clinical results. Each cannulation technique has different anatomical characteristics and a different flow pattern inside the aorta during cardiopulmonary bypass. Some adverse, clinically important outcomes may be related to events at this time. Femoral artery cannulation, axillary artery cannulation, and central aortic cannulation are the three major cannulation strategies that are adopted in many centers in the world. Accumulating results from comparative studies between right axillary artery cannulation and femoral artery cannulation show that right axillary artery cannulation is associated with better clinical outcomes. However, all of the studies have been retrospective, and few studies have compared the results of other combinations of cannulation strategies. Observational studies using newer monitoring techniques clearly show that no perfusion strategy is perfect or free from complications. In summary, the evidence is insufficient to make a strong recommendation regarding cannulation strategies. Based on the fairly consistent results of retrospective studies, more surgeons are tending to switch from a retrograde perfusion strategy to adopt an antegrade perfusion strategy. Regardless of the routine cannulation strategy that is adopted, careful monitoring and a swift response to adverse events are necessary. The further accumulation of evidence is warranted.

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“…[9][10][11] Cerebral malperfusion was diagnosed if patients with ATAAD had neurological symptoms and signs with ultrasonography or radiographic evidence of dissection of the corresponding aortic branch vessel. [12] However, a major drawback of this de nition is the absence of direct intracranial imaging evidence such as magnetic resonance imaging (MRI) demonstration of diffusion-weighted imaging (DWI) abnormalities. Imaging evidence of dissection in aortic arch branch vessels does not necessarily correspond to cerebral malperfusion.…”

Section: Introductionmentioning

confidence: 99%

Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

Zhao

Guo

et al. 2020

Preprint

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Background Stroke is a common postoperative complication in patients with acute type A aortic dissection (ATAAD). We aimed to explore the preoperative imaging risk findings for postoperative new stroke in patients with ATAAD. Methods From January 2015 to December 2018, 174 patients with ATAAD who underwent preoperative aortic computed tomography angiography (CTA) and cerebral diffusion-weighted imaging (DWI) as well as postoperative brain CT were included, and divided into DWI (+) and DWI (-) groups. Pre- and intraoperative variables were collected, and logistic regression analysis was used to determine the independent risk predictors of postoperative new stroke. Results The incidence of postoperative new stroke was 18.4% (32/174) in patients with ATAAD. Postoperative stroke was detected in 13 (31.0%) patients in the DWI (+) group and in 19 (14.4%) patients in the DWI (-) group with significant difference (P = 0.016). In the DWI (+) group, the lesions of the cerebral infarction located in the unilateral cerebral hemisphere and distributed more than three lobes (P = 0.007) were an independent risk factor for postoperative new stroke. Hypotension (P = 0.002), retrograde ascending aorta dissection with thrombosis of the false lumen (P = 0.010), aortic arch entry (P = 0.035), and coronary artery involvement (P = 0.001) were independent risk factors for postoperative stroke in the DWI (-) cohort. Conclusions Patients with ATAAD with cerebral infarction are more likely to develop postoperative new stroke; thus, a preoperative DWI examination may be necessary. DWI lesions distributed more than 3 lobes in the unilateral hemisphere suggest a high possibility of postoperative stroke. For patients with ATAAD with normal brain, particular attention should be given to the CTA findings of false lumen thrombosis, aortic arch entry, and coronary artery involvement to avoid postoperative stroke. Trial registration: Retrospectively registered.

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Extra-anatomic revascularization for preoperative cerebral malperfusion due to distal carotid artery occlusion in acute type A aortic dissection

Abstract: Extra-anatomic bypass for LCCA or RCCA occlusion allows for early selective cerebral perfusion during AADA repair, and may reduce the risk of neurological complications in patients with preoperative cerebral malperfusion.

Cited by 39 publications

References 13 publications

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection

The cannulation strategy in surgery for acute type A dissection

Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

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