The Supra-Aortic Vessels of Patients with Cerebral Ischemia in Stanford Type A Aortic Dissection
Journal
Journal of Radiological Science
Journal Volume
45
Date Issued
2020-03-01
Author(s)
Abstract
PURPOSE. To study the prevalence of the supra-aortic vessels involvement in Stanford type A aortic dissection, the characters of the involved supra-aortic vessels, the cerebral ischemic pattern, and its correlation to the characters of involved vessels in such patients. MATERIALS AND METHODS. We searched the picture archiving and communication system databank about the patients diagnosed to have Stanford type A aortic dissection and also acute ischemic stroke. We evaluated the supra-aortic vessels including the brachiocephalic, right common carotid, right internal carotid, right subclavian-vertebral, left common carotid, left internal carotid, and left subclavian-vertebral arteries. The demography, computed tomography angiography findings, and brain images were reviewed and analyzed. RESULTS. One hundred and five patients with type A aortic dissection were included in this study. They were 76 males and aged 27 to 95 years old (mean = 59.5, standard deviation = 14.4). Supra-aortic artery involved in 51 (48.6%) among them. They were 40 males and aged 29 to 87 years old (mean = 57.7, standard deviation = 14.0). Involvement of brachiocephalic artery and right common carotid was found in 30 patients (30/51 = 58.8%), right internal carotid artery (ICA) in 26 (51.0%), left common carotid artery in 26 (51.0%), left ICA in 24 (47.1%), left subclavian-vertebral artery in 22 (43.1%), and aberrant right subclavian artery in 1. Fifteen (14.3%) of these 51 patients were associated with cerebral ischemia. They were 8 males and aged 49 to 84 years old (mean = 70.3, standard deviation = 9.6). In these 15 patients, a total of 81 vessels were involved. Among them, double lumen with thrombotic false lumen noted in 21 vessels, patent both true and false lumen in 27, complete occlusion of artery in 23, and severe stenosis in 1. In their brain images, lesion found in one hemisphere in 8 patients (territorial infarction in 5 patients, borderzone infarction in 1 patient, embolic infarction in 2 patients), and in bilateral hemispheres in 7 patients (bilateral borderzone infarction in 2 patients, embolic in 1, diffuse loss of gray-white matter differentiation in 3, and 1 patient had right territorial infarction and left borderzone infarction). In the 4 patients with bilateral ICAs occlusion, they had bilateral lesions (3 loss of gray-white matter differentiation, 1 bilateral borderzone infarction). CONCLUSION. Type A aortic dissection complicated with acute ischemic stroke is not uncommon. The possibility of underlying aortic dissection in patient presenting as acute ischemic stroke should be kept in mind.
Subjects
acute ischemic stroke | aortic dissection | arch | computed tomography (CT) | CT angiography | vessels
SDGs
Type
journal article