Identification of CTA-Based Predictive Findings for Temporary and Permanent Neurological Dysfunction after Repair in Acute Type A Aortic Dissection.
Identification of CTA-Based Predictive Findings for Temporary and Permanent Neurological Dysfunction after Repair in Acute Type A Aortic Dissection.
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DOI：
10.1038/s41598-018-28152-z
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发表时间：
2018-06-27
影响因子：
4.6
通讯作者：
Zheng M
中科院分区：
文献类型：
--
作者：
Zhao H;Wen D;Duan W;An R;Li J;Zheng M
本研究的目的是确定预测急性A型主动脉夹层（ATAAD）手术修复后暂时性神经功能障碍（TND）和永久性神经功能障碍（PND）的CT风险表现。2013年1月至2016年6月，255例ATAAD患者（41±16岁，男性79%）连续行主动脉CT血管造影（CTA）和手术修复。对255例患者的胸主动脉和颈动脉CTA检查结果进行分析，以确定预测TND和PND的危险因素。38例（15%）出现TND， 18例（7%）出现PND。颈总动脉（CCA）剥离（OR = 4.63）、单侧ICA低增强（OR = 3.02）和主动脉弓撕裂（OR = 2.83）是术后TND的预测因素，而逆行升主动脉（aAO）剥离（OR = 5.62）和主动脉弓撕裂（OR = 6.74）是预测PND的最佳指标。在CCA夹层中，整个CCA和近端ICA的范围（P = 0.014）、低增强假腔再入（P = 0.000）和严重变窄的真腔无再入（P = 0.005）显著增加了术后TND的风险。在ATAAD患者中，特定的CT表现可以识别出术后TND和PND的个体风险，并可能指导后续的手术处理。
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.
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