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. 2024 Jan 2;13(1):e031542.
doi: 10.1161/JAHA.123.031542. Epub 2023 Dec 29.

Effect of Asymptomatic Common Carotid Artery Dissection on the Prognosis of Patients With Acute Type A Aortic Dissection

Songhao Jia  1 , Maozhou Wang  1 , Yuyong Liu  1 , Ming Gong  1 , Wenjian Jiang  1 , Hongjia Zhang  1
Affiliations

Effect of Asymptomatic Common Carotid Artery Dissection on the Prognosis of Patients With Acute Type A Aortic Dissection

Songhao Jia et al. J Am Heart Assoc. .

Abstract

Background: Acute type A aortic dissection can extend upwards to involve the common carotid artery. However, whether asymptomatic common carotid artery dissection (CCAD) requires surgical repair remains controversial. This study aimed to explore the effect of asymptomatic CCAD without surgical intervention on the prognosis of patients who underwent surgery for acute type A aortic dissection.

Methods and results: Between January 2015 and December 2017, 485 patients with no neurological symptoms who underwent surgery for acute type A aortic dissection were enrolled in this retrospective cohort study. The patients were divided into 2 groups based on the exposure factor of CCAD. CCAD was detected in 111 patients (22.9%), and after adjusting baseline data (standardized mean difference <0.1), the 30-day mortality (17.1% versus 6.0%, P<0.001) and incidence of fatal stroke (7.7% versus 1.6%, P=0.001) were significantly higher in the group with CCAD. Univariable and multivariable Cox regression analyses found CCAD as an independent risk factor for 30-day mortality (hazard ratio [HR], 2.8 [95% CI, 1.5-5.2]; P=0.001). At a median follow-up of 6.2 years (interquartile range, 5.6-6.9 years), landmark analysis with a cutoff value of 1 month postoperatively showed a significant increase in mortality in the group with CCAD, especially in the first month (log-rank P=0.002) and no significant difference in survival after the first month postoperatively between the 2 groups (log-rank P=0.955).

Conclusions: Asymptomatic CCAD increased the risk of early fatal stroke and death in patients with acute type A aortic dissection after surgery but did not affect midterm survival in patients who survived the early postoperative period.

Keywords: acute type a aortic dissection; cerebral malperfusion; common carotid artery dissection; prognosis.

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Figures

Figure 1
Figure 1. Study design.
CCAD indicates common carotid artery dissection; and SIPTW, stabilized inverse probability of treatment weighting.
Figure 2
Figure 2. Covariate balance.
AST indicates aspartate aminotransferase; SIPTW, stabilized inverse probability of treatment weighting; SMD, standardized mean difference; Tn I, troponin I; and WBC, white blood cell.
Figure 3
Figure 3. Kaplan–Meier curve without SIPTW (A) and with SIPTW (B).
x axis: follow‐up time since surgery (days); y axis: rate of survival probability. ATAAD indicates acute type A aortic dissection; CCAD, common carotid artery dissection; and SIPTW, stabilized inverse probability of treatment weighting.
Figure 4
Figure 4. Thirty‐day mortality of CCAD in subgroup analysis.
CABG indicates coronary angioplasty bypass grafting; CCAD, common carotid artery dissection; and HR, hazard ratio.
Figure 5
Figure 5. Kaplan–Meier curve and landmark analysis.
x axis: follow‐up time since surgery (months); y axis: rate of survival probability. ATAAD indicates acute type A aortic dissection; and CCAD, common carotid artery dissection.
See this image and copyright information in PMC

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