Identification of CTA-Based Predictive Findings for Temporary and Permanent Neurological Dysfunction after Repair in Acute Type A Aortic Dissection

Hongliang Zhao,Minwen Zheng,Jian Li,Rui An,Weixun Duan,Didi Wen

doi:10.1038/s41598-018-28152-z

Hongliang Zhao, Minwen Zheng + Show 4 more

Open Access

https://doi.org/10.1038/s41598-018-28152-z

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Journal: Scientific Reports	Publication Date: Jun 27, 2018
Citations: 6	License type: open-access

Affiliation: Air Force Medical University, Xijing Hospital

Abstract

The aim of this study was to determine CT risk findings predictive of temporary neurological dysfunction (TND) and permanent neurological dysfunction (PND) after surgical repair for acute type A aortic dissection (ATAAD). A total of 255 patients (41 ± 16 years, 79% male) with ATAAD underwent aortic CT angiography (CTA) and surgical repair consecutively from January 2013 to June 2016. The CTA findings of the 255 patients for the thoracic aorta and carotid artery were analysed to identify risk factors predictive of TND and PND. Thirty-eight patients (15%) suffered TND, and 18 (7%) exhibited PND. Common carotid artery (CCA) dissection (OR = 4.63), lower enhancement of unilateral ICA (OR = 3.02) and aortic arch tears (OR = 2.83) were predictors of postoperative TND, while PND was best predicted by retrograde ascending aorta (aAO) dissection (OR = 5.62) and aortic arch tears (OR = 6.74). In CCA dissection, the extent of the entire CCA and proximal ICA (P = 0.014), a low-enhancement false lumen with re-entry (P = 0.000) and a severely narrowed true lumen without re-entry (P = 0.005) significantly increased the risk of postoperative TND. In patients with ATAAD, specific CT findings allow the individual risk of postoperative TND and PND to be identified and may guide subsequent surgical management.

Highlights

Temporary neurological dysfunction (TND) and permanent neurological dysfunction (PND) represent the major neurological complications associated with surgical repair
In this retrospective study of patients with acute type A aortic dissection (ATAAD), we observed that Common carotid artery (CCA) dissection, lower enhancement in the unilateral ICA, and aortic arch tears are independent CT angiography (CTA) risk predictors for postoperative temporary neurological dysfunction (TND), while both retrograde ascending aorta (aAO) dissection and aortic arch tears are independent CTA risk predictors for PND
The extent of the entire CCA and proximal ICA involved, CCA re-entry and lower enhancement in the false lumen, and a severely narrowed true lumen in the CCA without re-entry significantly increased the risk of TND when the CCA was involved

Summary

Introduction

Temporary neurological dysfunction (TND) and permanent neurological dysfunction (PND) represent the major neurological complications associated with surgical repair. Several previous studies[3,5,6,7] have been undertaken to examine preoperative and procedural predictors of TND and PND as well as mortality after operations to address ATAAD. In addition to procedure-related risk factors, negative neurological outcomes are often related to the preoperative condition of cerebral malperfusion of the patient[7,8,9,10]. Adequate risk stratification of ATAAD patients based on the preoperative algorithm, especially in an emergency situation, is difficult due to the absence of apparent symptoms and signs for the surgeon to evaluate[11]. A number of modalities need to be applied to monitor the current status of patients with ATAAD to enable individual treatment and meticulous attention to critical procedural details

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