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Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review. J Pers Med 2022; 13:jpm13010058. [PMID: 36675719 PMCID: PMC9861720 DOI: 10.3390/jpm13010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
In this study, we report our local experience of type A aortic dissections in patients with cerebral malperfusion treated with carotid stenting before or after aortic surgery, and present a systematic literature review on these patients treated either with carotid stenting (CS) before or after aortic surgery (AS) or with aortic and carotid surgery alone (ACS). We report on patients treated in our center with carotid stenting for brain hemodynamic injury of carotid origin caused by type A dissection since 2018, and a systematic review was conducted in PubMed for articles published from 1990 to 2021. Out of 5307 articles, 19 articles could be included with a total of 80 patients analyzed: 9 from our center, 29 patients from case reports, and 51 patients from two retrospective cohorts. In total, 8 patients were treated by stenting first, 72 by surgery first, and 7 by stenting after surgery. The mean age; initial NIHSS score; time from symptom onset to treatment; post-treatment clinical improvement; post-treatment clinical worsening; mortality rate; follow-up duration; and follow-up mRS were, respectively, for each group (local cohort, CS before AS, ACS, CS after AS): 71.2 ± 5.3 yo, 65.5 ± 11.0 yo; 65.3 ± 13.1 yo, 68.7 ± 5.8 yo; 4 ± 8.4, 11.3 ± 8.5, 14.3 ± 8.0, 0; 11.8 ± 14.3 h, 21 ± 39.3 h, 13.6 ± 17.8 h, 13 ± 17.2 h; 56%, 71%, 86%, 57%; 11%, 28%, 0%, 14%; 25%, 12.3%, 14%, 33%; 5.25 ± 2.9 months, 54 months, 6.8 ± 3.8 months, 14 ± 14.4 months; 1 ± 1; 0.25 ± 0.5, 1.3 ± 0.8, 0.68 ± 0.6. Preoperative carotid stenting for hemodynamic cerebral malperfusion by true lumen compression appears to be feasible, and could be effective and safe, although there is still a lack of evidence due to the absence of comparative statistical analysis. The literature, albeit growing, is still limited, and prospective comparative studies are needed.
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Zhao Q, Yin K, Zhou N, Wu Q, Xiao Y, Zheng J, Zheng D, Bi Q, Quan L, Hu B, Cheng J. The characteristics of thoracic aortic dissection in autopsy-diagnosed individuals: An autopsy study. Front Cardiovasc Med 2022; 9:973530. [PMID: 36304553 PMCID: PMC9592848 DOI: 10.3389/fcvm.2022.973530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Thoracic aortic dissection (TAD) is the most common cause of sudden cardiac death associated with aortic diseases. The age of TAD victims in forensic studies is significantly younger than hospitalized patients with TAD, while only a few studies have been conducted on autopsy-diagnosed TAD deceased. A retrospective study was conducted at the Medicolegal Center of Sun Yat-sen University from 1999 to 2019 to address the characteristics of TAD victims. A total of 200 deceased from spontaneous rupture of TAD were assessed, with 165 (82.5%) males and 175 (87.5%) Stanford type A deceased. Our main results showed that compared with patients with TAD diagnosed during their lifetime, individuals diagnosed with TAD until an autopsy showed an earlier onset (43.80 years old) and less accompanied hypertension (<50%). Sudden death was the initial symptom of 32 decedents. Instead of chest/back pain (40 decedents), abdominal pain (59 decedents) was the most common initial symptom, and 42 decedents presented with no accompanying pain. A higher proportion of abdominal pain and the painless symptom was associated with a higher risk of misdiagnosis. Women showed a more atypical clinical presentation and rapid progression than men. Younger decedents showed more pronounced left heart changes. The present study implicated the TAD individuals diagnosed until an autopsy as a particular entity, indicating the urgent need for further investigation on early diagnosis and pathogenesis of patients with TAD with atypical pain and painless or with younger age to reduce the burden of TAD-related sudden death.
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Affiliation(s)
- Qianhao Zhao
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Kun Yin
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Nan Zhou
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Qiuping Wu
- Division of Forensic Medicine, Department of Pathology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Yuxi Xiao
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Jinxiang Zheng
- Department of Molecular Pathology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China,Henan Key Laboratory of Molecular Pathology, Zhengzhou, China
| | - Da Zheng
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Qiming Bi
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Li Quan
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Bingjie Hu
- Division of Forensic Medicine, Department of Pathology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China,*Correspondence: Bingjie Hu
| | - Jianding Cheng
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China,Jianding Cheng
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Asano H, Shimizu T, Aihara M, Yamaguchi R, Aishima K, Yoshimoto Y. Acute Endovascular Revascularization for Patients with Common Carotid Artery Occlusion Apparent on Cervical Magnetic Resonance Angiography. J Stroke Cerebrovasc Dis 2021; 30:105626. [PMID: 33516069 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES In the endovascular treatment of acute cerebral large-vessel occlusion, cervical magnetic resonance angiography (MRA) is a useful modality for assessing the access route. However, we sometimes encounter cases in which not only the internal carotid artery (ICA), but also the common carotid artery (CCA) is poorly visualized, leading to hesitation over which devices and techniques to choose for revascularization. We retrospectively evaluated such cases, focusing on image findings and treatment results. MATERIALS AND METHODS Data from 96 patients who underwent acute endovascular revascularization from January 2016 to December 2019 were analyzed. We extracted patients with poor CCA visualization on cervical MRA from 35 cases with ICA occlusion, and examined angiographic findings, treatment methods, and outcomes. RESULTS Poor visualization of the CCA in cervical MRA was observed in 8 cases. All cases displayed atrial fibrillation or sick sinus syndrome. Angiographic findings showed true CCA occlusion in 2 patients and ICA occlusion in 6 patients. Reasons for the inability to visualize the CCA on cervical MRA were speculated to be stenosis of the external carotid artery (ECA), presence of embolism in the ECA, or severe heart failure. In cases of true CCA occlusion, thrombus was aspirated using the balloon guide catheter and good recanalization was obtained. Seven of 8 patients displayed favorable recanalization, with good prognosis after 90 days in 5 patients. CONCLUSIONS Poor CCA visualization on cervical MRA does not necessarily represent true CCA occlusion. Aspiration of thrombus from a balloon guide catheter is effective for true CCA occlusion.
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Affiliation(s)
- Hirofumi Asano
- Department of Neurosurgery Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
| | - Tatsuya Shimizu
- Department of Neurosurgery Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
| | - Masanori Aihara
- Department of Neurosurgery Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
| | - Rei Yamaguchi
- Department of Neurosurgery Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
| | - Kaoru Aishima
- Department of Neurosurgery Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
| | - Yuhei Yoshimoto
- Department of Neurosurgery Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
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Salmasi MY, Al-Saadi N, Hartley P, Jarral OA, Raja S, Hussein M, Redhead J, Rosendahl U, Nienaber CA, Pepper JR, Oo AY, Athanasiou T. The risk of misdiagnosis in acute thoracic aortic dissection: a review of current guidelines. Heart 2020; 106:885-891. [PMID: 32170039 DOI: 10.1136/heartjnl-2019-316322] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 12/24/2022] Open
Abstract
Acute aortic syndrome and in particular aortic dissection (AAD) persists as a cause of significant morbidity and mortality despite improvements in surgical management. This clinical review aims to explore the risks of misdiagnosis, outcomes associated with misdiagnosis and evaluate current diagnostic methods for reducing its incidence.Due to the nature of the pathology, misdiagnosing the condition and delaying management can dramatically worsen patient outcomes. Several diagnostic challenges exist, including low prevalence, rapidly propagating pathology, non-discrete symptomatology, non-specific signs, analogy with other acute conditions and lack of management infrastructure. A similarity to acute coronary syndromes is a specific concern and risks patient maltreatment. AAD with malperfusion syndromes are both a cause of misdiagnosis and marker of disease complication, requiring specifically tailored management plans from the emergency setting.Despite improvements in diagnostic measures, including imaging modalities and biomarkers, misdiagnosis of AAD remains commonplace and current guidelines are relatively limited in preventing its occurrence. This paper recommends the early use of AAD risk scoring, focused echocardiography and most importantly, fast-tracking patients to cross-sectional imaging where the suspicion of AAD is high. This has the potential to improve the diagnostic process for AAD and limit the risk of misdiagnosis. However, our understanding remains limited by the lack of large patient datasets and an adequately audited processes of emergency department practice.
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Affiliation(s)
- M Yousuf Salmasi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nina Al-Saadi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Philip Hartley
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Omar A Jarral
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Shahzad Raja
- Cardiac Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Muthana Hussein
- Emergency Medicine, Kingston Hospital NHS Foundation Trust, Kingston upon Thames, London, UK
| | - Julian Redhead
- Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Ulrich Rosendahl
- Cardiac Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Christoph A Nienaber
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - John R Pepper
- Cardiac Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Aung Y Oo
- Cardiac Surgery, Barts Health NHS Trust, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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Matsubara S, Koga M, Ohara T, Iguchi Y, Minatoya K, Tahara Y, Fukuda T, Miyazaki Y, Kajimoto K, Sakamoto Y, Makita N, Tokuda N, Nagatsuka K, Ando Y, Toyoda K. Cerebrovascular imaging of cerebral ischemia in acute type A aortic dissection. J Neurol Sci 2018; 388:23-27. [PMID: 29627025 DOI: 10.1016/j.jns.2018.02.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/06/2018] [Accepted: 02/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stanford type A aortic dissection (AAD) sometimes causes acute ischemic stroke (AIS) or transient ischemic attack (TIA). There is little understanding of cerebrovascular imaging of AIS or TIA in patients with AAD. METHODS Consecutive AIS/TIA patients with AAD who were admitted within 4.5 h of onset were reviewed. We compared findings of MRI/MRA between these and consecutive AIS/TIA patients without AAD within 4.5 h of onset. RESULTS Seventeen AAD and 249 non-AAD patients were identified. Compared to non-AAD patients, AAD patients had infarcts more frequently in the right anterior cerebral artery (ACA) territory (18% vs. 2%, P = 0.007) and the right middle cerebral artery (MCA) territory (71% vs. 29%, P < 0.001). There was no difference between the groups regarding whether it was perforator or cortical infarct, single or multiple infarcts, unilateral or bilateral infarcts, or ischemic change extension. On the MRA imaging, the AAD patients more frequently had poor visualization of the right internal carotid artery (ICA) (47% vs. 6%, P < 0.001). After adjustment for sex, age and confounding factors, the right ACA territory infarct [odds ratio (OR), 12.2; 95% confidence interval (CI), 1.4-119.4], the MCA territory infarct (OR, 4.9; 95% CI, 1.0-25.0) and poor visualization of the right ICA (OR, 18.1; 95% CI, 4.0-101.9) were independently associated with AAD. CONCLUSION In emergency AIS/TIA patients, right anterior circulation infarct and poor visualization of the right ICA on cerebrovascular imaging are potential imaging markers of AAD.
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Affiliation(s)
- Soichiro Matsubara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masatoshi Koga
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Tomoyuki Ohara
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, Jikei University School of Medicine, Tokyo, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuichi Miyazaki
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Katsufumi Kajimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuki Sakamoto
- Department of Neurological Science, Nippon Medical School Hospital, Tokyo, Japan
| | - Naoki Makita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoki Tokuda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazuyuki Nagatsuka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Do YR. Aortic Dissection after Intravenous Thrombolysis in Acute Cerebral Infarction. KOSIN MEDICAL JOURNAL 2017. [DOI: 10.7180/kmj.2017.32.1.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Young Rok Do
- Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, Korea
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