Combined CT angiography of the aorta and craniocervical artery: a new imaging protocol for assessment of acute type A aortic dissection

The Guidance of Head-Neck-Aorta CT Angiography in Acute Type A Aortic Dissection Patients

BACKGROUND

The benefit of preoperative craniocervical artery imaging has not been elucidated for decision-making during the surgical repair of acute type A aortic dissection (ATAAD).

OBJECTIVES

The purpose of this study was to explore the clinical implication of a preoperative extended head-neck-aorta computed tomography angiography (CTA) among ATAAD patients.

METHODS

ATAAD patients undergoing surgical repair were retrospectively enrolled. Preoperatively, 215 patients underwent aortic CTA (conventional group) and 220 underwent extended CTA (extended group). In the extended group, the surgical team was informed of assessment of craniocervical arteries before the operation. The primary endpoint was postoperative transient neurological deficit and permanent neurological deficit. A 1:1 propensity score matching analysis was performed to account for baseline differences between groups, resulting in 154 pairs.

RESULTS

In the extended group, 135 patients were free of preoperative neurological symptoms, but 35 (25.9%) presented with severely stenosed or occluded common carotid artery. Common carotid artery reconstruction and cannulation combined with femoral artery cannulation (24.1% vs 5.1%; P < 0.001) and bilateral antegrade selective cerebral perfusion during hypothermic circulatory arrest (56.4% vs 19.1%; P < 0.001) were more adopted in the extended group. In the matched cohort, the extended CTA was significantly associated with fewer postoperative permanent neurological deficit (adjusted OR: 0.186; 95% CI: 0.059-0.587; P = 0.004) after adjustment with logistic regression.

CONCLUSIONS

The extended head-neck-aorta CTA protocol provided additional anatomical clarity preoperatively for modified surgical strategies and may subsequently improved the neurological outcomes of ATAAD.

Application of deep learning image reconstruction-high algorithm in one-stop coronary and carotid-cerebrovascular CT angiography with low radiation and contrast doses

Background

For patients with suspected simultaneous coronary and cerebrovascular atherosclerosis, conventional single-site computed tomography angiography (CTA) for both sites can result in nonnegligible radiation and contrast agent dose. The purpose of this study was to validate the feasibility of one-stop coronary and carotid-cerebrovascular CTA (C&CC-CTA) with a "double-low" (low radiation and contrast) dose protocol reconstructed with deep learning image reconstruction with high setting (DLIR-H) algorithm.

Methods

From February 2018 to January 2019, 60 patients referred to C&CC-CTA simultaneously in West China Hospital were recruited in this prospective cohort study. By random assignment, patients were divided into two groups: double-low dose group (n=30) used 80 kVp and 24 mgI/kg/s contrast dose with images reconstructed using DLIR-H; and routine-dose group (n=30) used 100 kVp and 32 mgI/kg/s contrast dose with images reconstructed using 50% adaptive statistical iterative reconstruction-V (ASIR-V50%). Radiation and contrast doses, subjective image quality score, CT attenuation values, noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured and compared between the groups.

Results

The DLIR-H group used 30% less contrast dose (35.80±4.85 vs. 51.13±6.91 mL) and 48% less overall radiation dose (1.00±0.09 vs. 1.91±0.42 mSv) than the ASIR-V50% group (both P<0.001). There was no statistically significant difference on subjective quality score between the two groups (C-CTA: 4.38±0.67 vs. 4.17±0.81, P=0.337 and CC-CTA: 4.18±0.87 vs. 4.08±0.79, P=0.604). For coronary CTA, lower background noise (18.93±1.43 vs. 22.86±3.75 HU) was reached in DLIR-H group, and SNR and CNR at all assessed branches were significantly increased compared to ASIR-V50% group (all P<0.05), except SNR of left anterior descending (P>0.05). For carotid-cerebrovascular CTA, DLIR-H group was comparable in background noise (19.25±1.42 vs. 20.23±2.40 HU), SNR and CNR at all assessed branches with ASIR-V50% group (all P>0.05).

Conclusions

The "double-low" dose one-stop C&CC-CTA with DLIR-H obtained higher image quality compared with the routine-dose protocol with ASIR-V50% while achieving 48% and 30% reduction in radiation and contrast dose, respectively.

Extra-anatomic revascularization and a new cannulation strategy for preoperative cerebral malperfusion due to severe stenosis or occlusion of supra-aortic branch vessels in acute type A aortic dissection

Objectives

Acute type A aortic dissection (ATAAD) with severe stenosis or occlusion of the true lumen of aortic arch branch vessels often leads to an increased incidence of severe postsurgical neurological complications and mortality rate. In this study, we aimed to introduce our institutional extra-anatomic revascularization and cannulation strategy with improved postoperative outcomes for better management of patients with cerebral malperfusion in the setting of ATAAD.

Methods

Twenty-eight patients with ATAAD complicated by severe stenosis or occlusion of the aortic arch branch vessels, as noted on combined computed tomography angiography of the aorta and craniocervical artery, between January 2021 and June 2022 were included in this study. Basic patient characteristics, surgical procedures, hospitalization stays, and early follow-up results were analyzed.

Results

The median follow-up duration was 16.5 months (interquartile range: 11.5-20.5), with a 100% completion rate. The 30-day mortality rates was 7.1% (2/28 patients); two patients had multiple cerebral infarctions on preoperative computed tomography and persistent coma. Postoperative transient neurological dysfunction occurred in 10.7% (3/28) of the patients, and no new permanent neurological dysfunction occurred. Of all the patients, 3.6% (1/28) had novel acute renal failure. No other deaths, secondary surgeries, or serious complications occurred during the early follow-up period.

Conclusions

Use of extra-anatomic revascularization and a new cannulation strategy before cardiopulmonary bypass is safe and feasible and may reduce the high incidence of postoperative neurological complications in patients with ATAAD and cerebral malperfusion.

Comparative Proteomic Investigation of Plasma Reveals Novel Potential Biomarker Groups for Acute Aortic Dissection

Acute aortic dissection (AAD) is a catastrophic cardiovascular disease with high disability and mortality due to multiple fatal complications. However, the molecular changes of the serum proteome after AAD are not very clear. Here, we performed isobaric tags for relative and absolute quantitation- (iTRAQ-) based comparative proteomic analysis to investigate the proteome profile changes after AAD by collecting plasma samples from 20 AAD patients and 20 controls. Out of the 345 identified proteins, 266 were considered as high-quality quantified proteins (95%confident peptides ≥ 2), of which 25 proteins were accumulated and 12 were reduced in AAD samples. Gene ontology enrichment analysis showed that the 25 AAD-accumulated proteins were enriched in high-density lipoprotein particles for the cellular component category and protein homodimerization acidity for the molecular function category. Protein-protein interaction network analysis showed that serum amyloid A proteins (SAAs), complement component proteins, and carboxypeptidase N catalytic chain proteins (CPNs) possessed the key nodes of the network. The expression levels of six selected AAD-accumulated proteins, B2-GP1, CPN1, F9, LBP, SAA1, and SAA2, were validated by ELISA. Moreover, ROC analysis showed that the AUCs of B2-GP1 and CPN1 were 0.808 and 0.702, respectively. Our data provide insights into molecular change profiles in proteome levels after AAD and indicate that B2-GP1 and CPN1 are potential biomarkers for AAD.