Triple-Branched Stent Graft for Acute Type A Aortic Dissection Complicated by Imaging Cerebral Malperfusion: A Multicentre Retrospective Study.

BACKGROUND

Patients with acute type A aortic dissection (ATAAD) complicated by imaging cerebral malperfusion (ICM) have poor prognoses. In this study we aimed to evaluate the clinical efficacy of the modified triple-branched stent graft (MTBSG) in these patients.

METHODS

In this retrospective comparative study we analyzed consecutive patients with ATAAD complicated by ICM between 2010 and 2019 who underwent either MTBSG implantation or conventional total arch replacement with frozen elephant trunk. The feasibility was assessed on the basis of intraoperative cerebral blood flow evaluation, early outcomes, long-term survival, neurological prognosis, long-term patency rate, and stent-related complications. The differences between clinical ICM and subclinical ICM patients were compared.

RESULTS

Among 145 enrolled patients, 48 underwent conventional total arch replacement with frozen elephant trunk and 97 received MTBSG implantation, with comparable baseline characteristics including preoperative neurological function, severity of carotid involvement, and state. After MTBSG implantation, all patients showed significant improvement in cerebral perfusion, accompanied by shorter cardiopulmonary bypass time and reduced selective cerebral perfusion duration. Although no differences were observed in hospital mortality or permanent neurological deficit rates, the MTBSG group showed potentially favourable trends including less incidence of intracerebral hemorrhage, better neurological recovery reflected by reduced National Institutes of Health Stroke Scale (NIHSS) scores, and improved 5-year survival. Long-term stent patency was well maintained (only 2 patients required intervention), and the stent-related complication rate was low (1 case).

CONCLUSIONS

This technique simplifies the surgical procedure, enhances safety, and provides a new strategy for managing ATAAD complicated by ICM. Future prospective studies with larger sample sizes are needed to further validate its long-term benefits.