Carotid Duplex Findings in Patients With Acute Type A Dissection

Abstract

Many patients with acute type A aortic dissection present with neurologic symptoms and have abnormal carotid duplex ultrasound (CDU) findings. We performed an analysis to determine the characteristics of CDU in acute type A aortic dissection. A prospectively maintained aortic database was queried for consecutive patients who underwent repair of acute type A aortic dissection between January 2002 and December 2011. Patients who had CDU during their hospitalization were reviewed. Analysis was performed to determine risk of pre- and postoperative stroke. We repaired 288 acute type A aortic dissection patients of which 87 patients had CDU during their hospitalization. Of the 87 patients, 61 (70%) had findings consistent with proximal dissection. Abnormalities noted on CDU included dissection flap on B-mode imaging, a second pulsed waveform after the initial systolic upstroke, and a widened and jagged systolic peak (Fig). A dissection flap extending into the common carotid arteries was visualized in 18 (21%) patients and was associated with preoperative stroke in 4 (22%) compared with 7 (10%) in those without a visualized dissection flap (P = .108). Overall, 20 of 288 (7%) patients had evidence of stroke at presentation. Aortic dissection should be considered in the presence of certain abnormal carotid waveforms-even in the absence of a visualized dissection flap. Recognition of these abnormal waveform patterns may expedite accurate diagnosis.