The Guidance of Head-Neck-Aorta CT Angiography in Acute Type A Aortic Dissection Patients (JACC Asia May 2025)-Article: The Guidance of Head-Neck-Aorta CT Angiography in Acute Type A Aortic Dissection Patients

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

Pdf Summary

The study explores the effectiveness of preoperative head-neck-aorta computed tomography angiography (CTA) in the surgical management of acute type A aortic dissection (ATAAD). Researchers retrospectively analyzed 435 ATAAD patients, with 220 undergoing an extended CTA scan that included craniocervical arteries, and 215 receiving conventional CTA. The extended CTA aimed to provide comprehensive anatomical insights, aiding surgical decisions, particularly in patients with common carotid artery (CCA) involvement, which often correlates with cerebral malperfusion and stroke.<br /><br />The extended CTA group had more strategic arterial cannulation and cerebral protection during surgery. Of the extended group, 54.5% showed no CCA dissection, while 45.5% had CCA involvement. Significant observations included a mismatch between neurological symptoms and CCA imaging, with over 50% of those patients exhibiting major CCA occlusions having no preoperative neurological symptoms. This highlights that extended CTA can uncover cerebral malperfusion potentially missed by standard symptom evaluation.<br /><br />Analyzing surgical outcomes, the extended CTA group exhibited fewer postoperative permanent neurological deficits (PND) compared to the conventional group (4.5% vs. 10.7%), although transient neurological deficiencies showed no significant difference. The mortality rates within 30 days post-surgery were similar across groups. Multivariable regression showed that extended CTA significantly reduced the odds of PND after adjusting for covariates.<br /><br />Overall, the study suggests that extended CTA provides critical anatomical insights that can refine surgical strategies, thereby potentially reducing neurological complications in ATAAD surgeries. Despite the promising results, the study's single-center, non-randomized design highlights the need for further validation in broader, multi-center prospective studies.

Keywords

preoperative CTA

acute type A aortic dissection

extended CTA scan

craniocervical arteries

common carotid artery

cerebral malperfusion

neurological deficits

surgical outcomes

arterial cannulation

stroke prevention