Long-term outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma

Tsukube, Takuro; Haraguchi, Tomonori; Okada, Yasushi; Matsukawa, Ritsu; Kozawa, S; Ogawa, Kenji; Okita, Yutaka

doi:10.1016/j.jtcvs.2014.06.053

Cited by 29 publications

(24 citation statements)

References 20 publications

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“…In the other patients, central repair is primarily performed without early reperfusion strategy. 6 In ultra-acute comatose patients with carotid artery occlusion, several types of reperfusion therapy, such as direct surgical fenestration of the carotid artery ( Figure 2), direct perfusion of the brachiocephalic artery after median sternotomy, and catheter intervention were performed depending on the attending surgeon's decision.…”

Section: Brain Malperfusionmentioning

confidence: 99%

Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion

Uchida

Karube

Kasama

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Section: Brain Malperfusionmentioning

confidence: 99%

Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion

Uchida

Karube

Kasama

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Older age and preoperative stroke have been reported as relative contraindications to immediate surgical repair of ATAAD owing to a higher operative morbidity and mortality [12][13][14]. In recent years, many publications have reported acceptable results after surgical repair or ATAAD in both elderly patients and those with preoperative stroke [15][16][17][18][19][20]. We have adopted the approach of emergent repair of ATAAD on most patients, with the exception of comatose patients [16].…”

mentioning

confidence: 99%

Determinants of Operative Mortality in Patients With Ruptured Acute Type A Aortic Dissection

Afifi¹,

Sandhu²,

Leake³

et al. 2016

The Annals of Thoracic Surgery

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“…Surgery within 5 h after onset of symptoms increases the likelihood of favourable outcome in patients who present with coma. 19 Given the fact that CT-perfusion can differentiate between irreversibly damaged and salvageable brain tissue, this technique may potentially aid in decision making regarding surgery in these patients, although this hypothesis has not been studied yet.…”

Section: Discussionmentioning

confidence: 99%

Aortic dissection masquerading as a code stroke: A single-centre cohort study

Guglielmi

Groeneveld

Posthuma

et al. 2019

European Stroke Journal

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Introduction: Data on the incidence of acute aortic dissection in the code stroke population are scarce. We report estimated incidence, clinical manifestations, treatment and outcomes of patients with an acute aortic dissection in a code stroke cohort from a comprehensive stroke centre. Patients and methods: We used data from a single-centre prospective registry of consecutive adult patients who presented to the emergency department between 2015 and 2018 with neurological deficits suggestive of an acute stroke ('code stroke'). All patients routinely underwent non-contrast computed tomography of the brain and computed tomography-angiography of the aortic arch, cervical and intracranial arteries. Results: Of 2874 code stroke patients, 1563 (54.4%) had acute ischaemia (ischaemic stroke or transient ischaemic attack). Fifteen patients (0.5% of code stroke patients and 0.8% of patients with acute ischaemia) had an acute aortic dissection (all Stanford classification type A). Discerning clinical manifestations were decreased consciousness in 11/15 (73%), pain in 8/15 (53%) and low systolic blood pressure (mean 106 mmHg, SD30). Acute aortic dissection was an incidental finding during computed tomography-angiography in 4/15 (27%). Two out of 15 patients (13%) received intravenous thrombolysis, 9/15 (60%) underwent aortic surgery and 10/15 (67%) died. Of those who survived, 3/5 (60%) had a good functional outcome (modified Rankin Scale 0-2). Discussion and Conclusion: In our comprehensive stroke centre, about 1/200 code stroke patients and 1/125 patients with acute ischaemia had an acute aortic dissection. Multicentre studies are necessary to acquire a more reliable estimate of the incidence of acute aortic dissection in the code stroke population. Given the ramifications of missing this diagnosis, imaging of the entire aortic arch is important in these patients.

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Long-term outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma

Abstract: The early and long-term outcomes as a result of immediate aortic repair for acute type A aortic dissection complicated by coma were satisfactory.

Cited by 29 publications

References 20 publications

Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion

Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion

Determinants of Operative Mortality in Patients With Ruptured Acute Type A Aortic Dissection

Aortic dissection masquerading as a code stroke: A single-centre cohort study

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