Impact of Carotid Artery Involvement in Type A Aortic Dissection
Authors: Maximilian Kreibich, Bartosz Rylski, Martin Czerny, Friedhelm Beyersdorf, Ryo Itagaki, Homare Okamura, Naoyuki Kimura, Atsushi Yamaguchi, Prashanth Vallabhajosyula, Wilson Y. Szeto, Joseph E. Bavaria, Nimesh D. Desai
Journal: Circulation (2019)

stroke Common carotid artery (CCA) dissection and cerebral malperfusion secondary to type A aortic dissection are feared complications with varying incidence and outcome. 1-4The aim of this study was to analyze the impact of CCA dissection and cerebral malperfusion in patients who were surgically treated for acute type A aortic dissection.The Penn-Saitama-Freiburg registry for CCA dissection in type A aortic dissection was established and includes 1444 patients without Marfan syndrome with available preoperative computed tomography angiography imaging who were operated on for acute type A aortic dissection between 2002 and 2017 at the University of Pennsylvania Health System in the United States, the Saitama Medical Center at the Jichi Medical University in Japan, and the Heart Center Freiburg University at the University of Freiburg in Germany.A total of 1004 patients (70%) did not have any CCA dissection, 279 patients (19%) presented with unilateral CCA dissection, and 161 patients (11%) had bilateral CCA dissection.Because there were no statistical differences between patients with unilateral or bilateral CCA dissection, clinical characteristics, radiographic images, and in-hospital and late outcomes were compared between patients with no CCA dissection and patients with CCA dissection (440 patients).A modified Rankin scale was used to evaluate postoperative outcome in patients with in-hospital stroke.Acceptable clinical outcome was defined as modified Rankin scale 0 to 3; poor neurological outcome was defined as modified Rankin scale 4 to 5. The institutional review committees at all 3 centers approved this retrospective study (Philadelphia: institutional review board #823238; Saitama: institutional review board #S18-009; Freiburg: institutional review board #241/14).Statistical methods included ANOVA, the Kruskal-Wallis test, and the χ 2 test or Fisher exact test in case n<5.Multivariable logistic regression was performed to analyze independent predictors of in-hospital mortality and in-hospital stroke.A competing risk analysis for freedom from stroke during follow-up was performed.Late survival and freedom from stroke were analyzed using the Kaplan-Meier method and the log rank test.Data are presented as median (first quartile, third quartile) or as number (percentage).Patients with no CCA involvement were significantly older than patients with CCA involvement (no CCA involvement, 64 [54, 74] versus CCA involvement, 60 [51, 70]; P<0.001).A preoperative neurological deficit in the absence of hemodynamic compromise was significantly more common in patients with CCA dissection (33 [3%] versus 101 [23%] patients; P<0.001).Patients without any CCA involvement had a significantly lower incidence of a more distal aortic dissection involving the descending thoracic aorta (613 [61%] versus 379 [86%] patients; P<0.001), the abdominal aorta (508 [51%] versus 339 [77%] patients; P<0.001), or any iliac artery (304 [30%] versus 257 [58%] patients; P<0.001).