Triple-Branched Stent Graft for Acute Type A Aortic Dissection Complicated by Imaging Cerebral Malperfusion: A Multi-Center Retrospective Study

Patients with acute type A aortic dissection (ATAAD) complicated by imaging cerebral malperfusion (ICM) have poor prognoses. This study aimed to evaluate the clinical efficacy of the modified triple-branched stent graft (MTBSG) in these patients. This retrospective comparative study analyzed consecutive patients with ATAAD complicated by ICM between 2010 and 2019 undergoing either MTBSG implantation or conventional total arch replacement with frozen elephant trunk (TAR+FET). The feasibility was assessed based on intraoperative cerebral blood flow evaluation, early outcomes, long-term survival, neurological prognosis, long-term patency rate and stent-related complications. The differences between clinical ICM and subclinical ICM patients were compared. Among 145 enrolled patients, 48 underwent conventional TAR+FET and 97 received MTBSG implantation, with comparable baseline characteristics including preoperative neurological function, severity of carotid involvement, and state. Following MTBSG implantation, all patients demonstrated significant improvement in cerebral perfusion, accompanied by shorter cardiopulmonary bypass time and reduced selective cerebral perfusion duration. While no differences were observed in hospital mortality or permanent neurological deficit rates, the MTBSG group showed potentially favorable trends including a lower incidence of intracerebral hemorrhage, better neurological recovery reflected by reduced NIHSS scores and improved 5-year survival. Long-term stent patency was well maintained (only 2 patients required intervention), and the stent-related complication rate was low (1 case). This technique simplifies the surgical procedure, enhances safety and provides a new strategy for managing ATAAD complicated by ICM. Future prospective studies with larger sample sizes are needed to further validate its long-term benefits.