Type A Acute Aortic Dissection Complicated With Cerebral Malperfusion

A Acute Aortic Dissection (TAAAD) has been associated with a poor prognosis without prompt optimal management.Even though the overall mortality declined over these years, the in-hospital mortality was still high up to 19.7% for those patients receiving emergent surgery and 57.1% in those medically treated based on a 17-year analysis of International Registry of Acute Aortic Dissection (IRAD) [1].The most typical symptom of patients with TAAAD is abrupt onset of chest and/or back pain, often depicted as the worst one they have ever experienced.Besides, dissecting plane may sometimes obstruct the blood flow distribution to peripheral organ or even lead to generalized ischemia, causing malperfusion and leading to adverse outcomes [2].The associated clinical manifestations depend on the ischemic location and can be divided into localized ischemia (cerebral, spinal, mesenteric, renal, limb, and coronary malperfusion) and generalized ischemia.The reported overall incidence of malperfusion is 21-33% and the in-hospital mortality is 16-44% [3][4][5].Considering Cerebral Malperfusion (CM), it accounts for an incidence of 8-26% [3,4,6].The definition varies among centers.Pacini et al.,[3] defined CM as stroke or transient ischemic attack, while Morimoto et al., [6] defined it with symptoms of newly developed neurologic deficits along with evidence from contrast CT or carotid ultrasonography of decreased blood flow in carotid arteries.Image modality is valid to assist in diagnosis since most cases develope dissection of supra-aortic branches [7] (Figure 1).