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Neuroanatomy and Severity of Stroke in Patients with Type A Aortic Dissection
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  • Akash Fichadiya,
  • Bijoy Menon,
  • Alex Gregory,
  • Ericka Teleg,
  • Jehangir Appoo
Akash Fichadiya
University of Calgary Cumming School of Medicine
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Bijoy Menon
University of Calgary Cumming School of Medicine
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Alex Gregory
University of Calgary Cumming School of Medicine
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Ericka Teleg
University of Calgary Cumming School of Medicine
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Jehangir Appoo
University of Calgary Cumming School of Medicine
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Abstract

Background: Strokes are a known complication of acute type A aortic dissection (ATAAD) repair. Understanding the neuroanatomy, mechanism, and severity of stroke will facilitate efforts to improve prediction, prevention, and treatment strategies. Methods: Retrospective review of patients who sustained stroke from a consecutive series of patients undergoing ATAAD repair. Neuroimaging was interpreted by two stroke neurologists blinded to clinical results. Severity of stroke was assessed by National Institutes of Health Stroke Scale (NIHSS). Residual disability at thirty days was assessed using the modified Rankin Scale (mRS). Results: Twenty percent (38/189) of patients undergoing repair for ATAAD had stroke [unilateral 58%, bi-hemispheric 42% (p=0.33)]. All strokes were ischemic. No significant lateralization (right vs. left) was noted with unilateral strokes (26% vs 32%, p=0.67). Etiology of stroke was embolic (58%), hypoperfusion (26%), mixed (11%) and unknown (5%). There were no intraoperative variables that correlated with the neuroanatomy or mechanism of stroke. Pre-operative carotid dissection was seen in 40% (n=15), while postoperatively 10% (n=4) sustained intracranial large vessel occlusion (LVO). Strokes were moderate or severe (NIHSS ≥ 9) in 97% of cases, with 66% incidence of moderate residual disability (mRS ≥ 3) at one month postoperatively. Conclusions: Stroke associated with ATAAD is heterogeneous in etiology and location. Most strokes are severe on detection and result in significant residual disability. One in 10 strokes are due to LVO amenable to endovascular treatment. Future trials may evaluate the role for early neuroimaging and treatment of incident stroke given modern advancements in endovascular stroke therapy.

Peer review status:UNDER REVIEW

14 Jul 2021Submitted to Journal of Cardiac Surgery
15 Jul 2021Submission Checks Completed
15 Jul 2021Assigned to Editor
16 Jul 2021Reviewer(s) Assigned
11 Aug 2021Review(s) Completed, Editorial Evaluation Pending
12 Aug 2021Editorial Decision: Revise Major
11 Sep 20211st Revision Received
11 Sep 2021Submission Checks Completed
11 Sep 2021Assigned to Editor
11 Sep 2021Reviewer(s) Assigned
23 Sep 2021Review(s) Completed, Editorial Evaluation Pending