Abstract
Introduction: Stroke is a frequent complication in patients having surgery for Acute Type A Aortic Dissection (ATAAD) where a variety of neurocirculatory techniques are used to reconstruct the arch. In order for surgeons to prevent stroke, first an understanding of the dynamic hemodynamic processes that cause stroke is required. Objective of this study is to determine radiological characteristics and mechanisms of stroke in ATAAD. So far, surgical literature has only reported on incidence. Methods: From 2006-2016, of 189 ATAAD patients at a single centre, 42 had a stroke. Charts and brain imaging were reviewed by 2 Neurologists. Great vessel pathology along with willisian collateral status was identified. Stroke territory (anterior or posterior circulation), distribution (unilateral or bilateral) and number of lesions were identified. Mechanism of stroke was classified as hypoperfusion (water-shed, borderzone pattern), embolic (cortical multiple or wedge shaped) or combined. Results: All strokes were ischemic. Mean patient age 60.1 +/- 13.1 years. Stroke was diagnosed a median 3.0 days (IQR = 5.1) post operatively. NIHSS classification was mild in 7%, moderate in 81% and 12% had severe. Most strokes were multiple (65%) and in the anterior circulation (88% vs. 32 % posterior). Most patients had an embolic pattern of stroke (45% vs. 36% hypoperfusion vs 17% mixed). Detailed clinical and radiologic data are shown in Table 1. Conclusion: Stroke after ATAAD is ischemic, predominantly embolic, involves both hemispheres and results in significant morbidity. It remains unclear if stroke is a result of the dissection disease process extending to the brain vs. iatrogenically caused by choice and methodology of intraoperative surgical neurocirculatory management strategies used to reconstruct the aorta. Further studies will look for associations between pre-operative cerebrovascular abnormalities, intra-operative management, and mechanisms of stroke.
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