Brachiocephalic artery dissection is a marker of stroke after acute type
A aortic dissection repair
Abstract
OBJECTIVE Postoperative stroke is a serious unsolved complication after
acute type A aortic dissection repair. We investigated the incidence and
risk factors of stroke and hypothesized that dissection of supra-aortic
vessels is an important risk factor of this morbidity. METHODS Between
2012 and 2019, 202 (56% men, median age 68 years) patients with acute
type A aortic dissection underwent surgical repair. Clinical data, image
findings, methods of circulatory support, and repair technique were
retrospectively investigated to explore the risk factor of postoperative
stroke. RESULTS Of 202 patients, operative mortality was 6% and the
incidence of postoperative stroke was 12% (n=25). Brachiocephalic
artery dissection was associated with a higher risk of stroke (odds
ratio, 3.89, 95%CI 1.104-13.780; P= .035) having no relation with the
presence or absence of left common carotid artery dissection.
Preoperative malperfusion syndrome, circulatory arrest time, isolated
cerebral perfusion time, repair technique (total arch replacement), and
femoral artery perfusion alone were not related to the incident rate of
postoperative stroke. Stroke occurred in both hemispheres, regardless of
the laterality of carotid artery dissection. CONCLUSION Brachiocephalic
artery dissection was an independent risk factor of stroke after acute
type A aortic dissection repair.