Correlation between preoperative brain computed tomography perfusion and postoperative permanent stroke in patients with acute type A aortic dissection with severe common carotid artery stenosis

Shi Heng; Wang Dongxu; Jin Zhenxiao; Yang Chen; Chen Tao; Jiang Liqing; Si Yi; Yu Shiqiang; Zhang Wenlong

doi:10.13498/j.cnki.chin.j.ecc.2024.02.07

Abstract：Objective To investigate the correlation between preoperative computed tomography perfusion(CTP)and postoperative new ischemic stroke(IS)in patients with acute type A aortic dissection(ATAAD)with severe common carotid artery stenosis.Methods The record data of 40 ATAAD patients with severe carotid artery stenosis who underwent preoperative CTP and surgical treatment in our center were retrospectively analyzed.Cerebral blood flow(CBF),cerebral blood volume(CBV),mean transmit time(MTT),time to maximum(Tmax)and cerebral infarction volume were used to quantify cerebral perfusion.Univariate and multivariate logistic regression analyses were performed to identify clinical and radiographic predictors associated with postoperative new onset IS.Results Of the 40 patients included,15(37.5%)developed new post-operative IS.Univariate analysis showed that internal carotid artery dissection,affected side CBF,affected side CBV and cerebral infarction volume were associated with postoperative new IS.Further multivariate logistic analysis showed that the affected side CBF(OR:0.865,95%CI:0.752-0.994,P = 0.041),affected side CBV(OR:0.087,95%CI:0.006-1.335,P = 0.080)and cerebral infarction volume(OR:1.152,95%CI:1.017-1.306,P = 0.027)were independent predictor of postoperative new IS.The area under the subject working characteristic curve of the affected side CBF for predicting postoperative new IS was 0.779(95%CI:0.636～0.921),and the optimal cutoff value was 44.65 ml/100 ml/min.With the affected side CBF = 44.65 ml/100 ml/min as the critical value,the low CBF group was divided into the low CBF group and the high CBF group.The analysis showed that the proportion of all-cause death,new postoperative IS and adverse outcome within 30 days after surgery in the low CBF group was higher than that in the high CBF group(P = 0.017,P = 0.001,P<0.001).Conclusion CBF,CBV and infarct volume are independent predictors of postoperative new IS in ATAAD patients with severe carotid artery stenosis.Cerebral CTP is a feasible method for quantitative and objective evaluation of cerebral malperfusion.The lower the preoperative cerebral CTP,the higher the risk of new IS after surgery.