Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection.
Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection.
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急性 A 型主动脉夹层患者术后新发卒中的术前影像学风险发现
DOI：
10.3389/fcvm.2020.602610
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发表时间：
2020
影响因子：
3.6
通讯作者：
Zheng M
中科院分区：
文献类型：
--
作者：
Zhao H;Guo F;Xu J;Zhu Y;Wen D;Duan W;Zheng M
背景：卒中是急性A型主动脉夹层（ATAAD）患者常见的术后并发症。我们的目的是探索ATAAD患者术后新发中风的术前影像学风险发现。研究方法：纳入2015年1月至2018年12月期间接受术前主动脉计算机断层扫描血管造影（CTA）和脑弥散加权成像（DWI）以及术后脑部CT检查的174例ATAAD患者，并分为DWI（+）和DWI（-）组。收集术前和术中变量，并使用逻辑回归分析确定术后新发卒中的独立风险预测因子。结果：ATAAD患者术后新发脑卒中发生率为18.4%（32/174）。DWI（+）组13例（31.0%）患者和DWI（-）组19例（14.4%）患者检测到术后卒中，差异有统计学意义（P = 0.016）。在DWI（+）组中，病灶位于单侧大脑半球且分布于3个以上脑叶的脑梗死（P = 0.007）是术后新发脑卒中的独立危险因素。在DWI（-）队列中，低血压（P = 0.002）、逆行性升主动脉夹层伴假腔血栓形成（P = 0.010）、主动脉弓进入（P = 0.035）和冠状动脉受累（P = 0.001）是术后卒中的独立风险因素。结论：伴有脑梗死的ATAAD患者更有可能发生术后新发卒中;因此，术前DWI检查可能是必要的。DWI病灶在单侧半球分布超过3个脑叶提示术后卒中的可能性高。对于大脑正常的ATAAD患者，应特别注意CTA结果，包括假腔血栓形成、主动脉弓进入和冠状动脉受累，以避免术后卒中。
Background: Stroke is a common postoperative complication in patients with acute type A aortic dissection (ATAAD). We aimed to explore the preoperative imaging risk findings for postoperative new stroke in patients with ATAAD. Methods: From January 2015 to December 2018, 174 patients with ATAAD who underwent preoperative aortic computed tomography angiography (CTA) and cerebral diffusion-weighted imaging (DWI) as well as postoperative brain CT were included, and divided into DWI (+) and DWI (–) groups. Pre- and intraoperative variables were collected, and logistic regression analysis was used to determine the independent risk predictors of postoperative new stroke. Results: The incidence of postoperative new stroke was 18.4% (32/174) in patients with ATAAD. Postoperative stroke was detected in 13 (31.0%) patients in the DWI (+) group and in 19 (14.4%) patients in the DWI (–) group with significant difference (P = 0.016). In the DWI (+) group, the lesions of the cerebral infarction located in the unilateral cerebral hemisphere and distributed more than three lobes (P = 0.007) were an independent risk factor for postoperative new stroke. Hypotension (P = 0.002), retrograde ascending aorta dissection with thrombosis of the false lumen (P = 0.010), aortic arch entry (P = 0.035), and coronary artery involvement (P = 0.001) were independent risk factors for postoperative stroke in the DWI (–) cohort. Conclusions: Patients with ATAAD with cerebral infarction are more likely to develop postoperative new stroke; thus, a preoperative DWI examination may be necessary. DWI lesions distributed more than 3 lobes in the unilateral hemisphere suggest a high possibility of postoperative stroke. For patients with ATAAD with normal brain, particular attention should be given to the CTA findings of false lumen thrombosis, aortic arch entry, and coronary artery involvement to avoid postoperative stroke.
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影响因子：
3.4
作者：
Luehr, Maximilian;Etz, Christian D.;Mohr, Friedrich-Wilhelm
通讯作者：
Mohr, Friedrich-Wilhelm
影响因子：
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Haldenwang, Peter L.;Wahlers, Thorsten;Strauch, Justus T.
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Strauch, Justus T.
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作者：
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通讯作者：
Torp-Pedersen, Christian
影响因子：
37.8
作者：
Evangelista, Arturo;Isselbacher, Eric M.;Eagle, Kim A.
通讯作者：
Eagle, Kim A.