Key result
Preoperative cIMT >0.9 mm is linked to ~9.5-fold greater stroke risk after acute type A dissection repair.
Why the study?
Stroke is a serious adverse outcome after surgical repair for acute type A aortic dissection, and it remained unknown whether carotid intima-media thickness reliably predicts postoperative stroke risk.
Does preoperative cIMT predict postoperative stroke in patients with ATAAD undergoing aortic arch repair?
Observational (n=76)
No
Does preoperative cIMT predict postoperative stroke in patients with ATAAD undergoing aortic arch repair?
Odds Ratio: 9.53 (95% CI 1.47–61.72)
p-value: p=0.018
Preoperative cIMT > 0.9 mm is an independent predictor of postoperative stroke in patients undergoing surgical repair of acute type A aortic dissection.
cIMT >0.9 mm was associated with postoperative stroke after ATAAD repair; leaves open its utility for preoperative risk stratification.
BACKGROUND: Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires surgical intervention. Stroke remains an extremely serious adverse outcome that can occur in ATAAD patients undergoing aortic arch repair, leading to higher rates of patient mortality and decreased postoperative quality of life. In the present study, we sought to determine whether carotid intima-media thickness (cIMT) is a reliable predictor of postoperative stroke risk. MATERIALS AND METHODS: This was a prospective study of 76 patients with ATAAD undergoing aortic arch repair. For all patients, cIMT was determined preoperatively through a Doppler-based method. Incidence of different forms of neurological dysfunction, including temporary neurological dysfunction (TND) and stroke, was monitored in these patients, and the relationship between cIMT and stroke incidence was assessed using a receiver-operating characteristic (ROC) curve. Prognostic variables associated with stroke risk were further identified through univariate and multivariate analyses. RESULTS: A total of 26/76 (34.2%) patients in the present study suffered from neurological dysfunction, of whom 16 (21.0%) suffered from TND and 10 (13.2%) suffered a stroke. The remaining 50 patients (65.8%) did not suffer from neurological dysfunction. The cIMT values in the stroke, TND, and neurological dysfunction-free patients in this study were 1.12 ± 0.19 (mm), 0.99 ± 0.13 (mm), and 0.87 ± 0.13 (mm), respectively. A total of 4 patients in this cohort died during the study, including 1 in the TND group and 3 in the stroke group. An ROC curve analysis indicated that cIMT could predict stroke with an area under the curve value of 0.844 (95% CI, 0.719-0.969; p < 0.001). A multivariate analysis revealed that cIMT > 0.9 mm was independently associated with stroke risk (p = 0.018). CONCLUSION: We found that cIMT can be used to predict postoperative stroke risk in ATAAD patients undergoing aortic arch repair, with a cIMT > 0.9 mm coinciding with increased stroke risk in these patients. TRIAL REGISTRATION: ChiCTR1900022289. Date of registration 4 April 2019 retrospectively registered.
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Zhang et al. (2020) conducted an observational in Acute type A aortic dissection (ATAAD) (n=76). Carotid intima-media thickness (cIMT) > 0.9 mm vs. cIMT ≤ 0.9 mm was evaluated on Postoperative stroke (OR 9.53, 95% CI 1.47-61.72, p=0.018). Preoperative carotid intima-media thickness > 0.9 mm was independently associated with an increased risk of postoperative stroke (OR 9.53) in patients undergoing repair of acute type A aortic dissection.
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