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Clinical Trial
. 2025 Jul 1;67(7):ezaf199.
doi: 10.1093/ejcts/ezaf199.

Cerebral malperfusion resolution after repair of acute DeBakey type I dissection with a novel hybrid prosthesis: early results of the PERSEVERE Study†

William Brinkman  1 , John J Squiers  1 , Arminder Jassar  2 , Shinichi Fukuhara  3 , Fernando Fleischman  4 , Hiroo Takayama  5 , Ibrahim Sultan  6 , George Arnaoutakis  7 , Michael C Moon  8 , Wilson Y Szeto  9 ; PERSEVERE Investigators
Collaborators, Affiliations
Clinical Trial

Cerebral malperfusion resolution after repair of acute DeBakey type I dissection with a novel hybrid prosthesis: early results of the PERSEVERE Study†

William Brinkman et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: Patients undergoing hemiarch repair for acute DeBakey type I dissection (ADTI) are high risk for postoperative stroke, especially if cerebral malperfusion is present preoperatively. We sought to evaluate whether the AMDS Hybrid Prosthesis (AMDS), a bare metal stent designed to promote positive aortic remodelling and prevent distal anastomotic new entry tears, may improve neurological outcomes of patients with ADTI presenting with cerebral malperfusion.

Methods: PERSEVERE enrolled patients presenting with ADTI and malperfusion at 26 sites in North America. Among 93 enrolled patients, 30 (32.3%) presented with cerebral malperfusion. We evaluated for resolution of clinical and/or radiological cerebral malperfusion after hemiarch repair with AMDS.

Results: Cerebral malperfusion was diagnosed clinically in 19 (63.3%) patients and radiographically in 23 (76.7%) patients. Among the patients with clinical cerebral malperfusion, 18 survived the perioperative period; of these, 11 (61%) experienced complete resolution of preoperative symptoms, 5 (28%) had no worsening of preoperative symptoms, and 2 (11%) had a new disabling stroke postoperatively. At follow-up, the mean true lumen to total arterial diameter ratio (measured by computed tomography angiography) improved from 30.9% to 64.4% (P = 0.002) in the innominate artery and 33.8% to 60.6% (P = 0.005) in the left common carotid artery from preoperative baseline in patients with radiographic cerebral malperfusion.

Conclusions: Among patients presenting with ADTI and cerebral malperfusion, the majority had resolution or stability of neurological symptoms after hemiarch repair using the AMDS. Radiographic indicators of malperfusion also improved.

Clinical trial registration: https://clinicaltrials.gov/study/NCT05174767.

Keywords: Acute DeBakey type I aortic dissection; Cerebral malperfusion; False lumen thrombosis; Hemiarch repair; Hybrid aortic prosthesis.

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Figures

None
Graphical abstract
Figure 1:
Figure 1:
Patient selection flow diagram. Subjects presenting with clinical or radiographic (or both) signs of cerebral malperfusion were included in this sub-study of the PERSEVERE trial.
Figure 2:
Figure 2:
Mean true lumen to total arterial diameter (TL: TAD) ratio, expressed by percentage, as measured on computed tomography angiography at preoperative baseline and 30 days postoperatively in patients with acute DeBakey type I aortic dissection and radiographic cerebral malperfusion evident in the innominate artery (IA) or left common carotid artery (LCCA).
Figure 3:
Figure 3:
Representative core lab imaging measurements demonstrating improvement in true lumen to total arterial diameter ratio in the innominate artery from preoperative baseline to the 30-day postoperative timepoint.
Figure 4:
Figure 4:
Rates of false lumen thrombosis and patency in the innominate and left common carotid arteries of patients presenting with acute DeBakey type I aortic dissection and radiographic cerebral malperfusion from preoperative baseline to 30-day postoperative timepoint. Thrombosis was assessed on computed tomography angiography by an independent imaging core laboratory.
See this image and copyright information in PMC

References

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