Thorac Cardiovasc Surg 2019; 67(S 01): S1-S100
DOI: 10.1055/s-0039-1678943
Oral Presentations
Tuesday, February 19, 2019
DGTHG: Aortenerkrankungen (Typ A Dissektion)
Georg Thieme Verlag KG Stuttgart · New York

Common Carotid Artery Occlusion Secondary to Type A Aortic Dissection

M. Kreibich
1   Universitäts-Herzzentrum Freiburg - Bad Krozingen, Klinik für Herz- und Gefäßchirurgie, Freiburg, Germany
2   Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, United States
,
N. Desai
2   Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, United States
,
J. Bavaria
2   Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, United States
,
H. Okamura
3   Department of Cardiovascular Surgery, Jichi Medical University, Saitama, Japan
,
N. Kimura
3   Department of Cardiovascular Surgery, Jichi Medical University, Saitama, Japan
,
A. Yamaguchi
3   Department of Cardiovascular Surgery, Jichi Medical University, Saitama, Japan
,
F. Beyersdorf
1   Universitäts-Herzzentrum Freiburg - Bad Krozingen, Klinik für Herz- und Gefäßchirurgie, Freiburg, Germany
,
B. Rylski
1   Universitäts-Herzzentrum Freiburg - Bad Krozingen, Klinik für Herz- und Gefäßchirurgie, Freiburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
28 January 2019 (online)

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Objectives: To evaluate the outcome of patients with unilateral or bilateral common carotid artery (CCA) occlusion secondary to acute Type A aortic dissection.

Methods: A trinational registry for CCA dissection in acute Type A aortic dissection, including 1,444 patients, was screened for patients with CCA occlusion. Sixty-one patients aged 64 ± 11 years were identified and clinical, radiographic, and outcome data were analyzed. Postoperative outcome was classified using a Modified Rankin Score (MRS) as acceptable (MRS: 0–3) or as poor (MRS: 4–6).

Results: The right CCA was occluded in 52 patients (85%), the left CCA was occluded in 13 patients (21%), and bilateral occlusion was diagnosed in 4 patients (7%) Thirty-three patients (54%) presented with a preoperative neurologic deficit in the absence of hemodynamic compromise. Noncerebral other organ malperfusion was diagnosed in 26 patients (43%), and 21 patients (34%) developed shock. Thirty-one patients (51%) were diagnosed with postoperative stroke and 5 patients (8%) with a temporary neurologic deficit. In hospital mortality was 21% (13 patients). An acceptable clinical outcome was observed in 33 patients (54%) and a poor clinical outcome in 28 patients (46%). Of the four patients with bilateral CCA occlusion, all patients were diagnosed with postoperative stroke, three patients died in-hospital and one patient expired shortly after discharge.

Conclusion: Patients with occlusion of a CCA secondary to acute Type A aortic dissection are at high risk for perioperative stroke and perioperative mortality is high. However, more than half of all patients are discharged with an acceptable clinical outcome. Thus, a surgical approach should not be denied to patients with unilateral CCA occlusion. In case of bilateral CCA occlusion, surgery seems to be a salvage option, but the perioperative outcome is dismal.