Neurological prognosis stratified by computed tomography perfusion in patients with cerebral malperfusion secondary to acute type A aortic dissection.

BACKGROUND: Recent work confirms the utility of computed tomography perfusion (CTP) for cerebral malperfusion secondary to acute Stanford type A aortic dissection (AAAD). This study validated whether CTP parameters can be utilized as neurological predictors. METHODS: Since 2020, 380 patients hospitalized for AAAD were retrospectively reviewed. Among these, 31(8.2%) patients with stable hemodynamics and preoperative neurological symptoms were divided into two groups stratified by CTP parameters: 15 with ischemic core (ischemic core group) and 16 without ischemic core but with penumbra (penumbra group). RESULTS: Preoperative patient data including age, sex, distal extent of aortic dissection, and modified Rankin scale (mRS) were comparable between the two groups. Proportions of patients with preoperative National Institutes of Health Stroke Scale (NIHSS) ≥ 14 were significantly higher in the ischemic core group than in the penumbra group (75% vs. 13%, P = 0.02), and brain area perfusion > 10 s occurred significantly more often in the ischemic core group (158 vs. 0 mL, P = 0.08). Among the enrolled survivors, freedom from all-cause mortality 2 years after operation was lower in the ischemic core group (78% vs. 100%, P = 0.04). At the latest follow-up, mRS ≥ 3 was more frequent in the ischemic core group than in the penumbra group (60% vs. 19%, P = 0.02). CONCLUSIONS: CTP could detect irreversible ischemic core at the hyperacute phase in patients with cerebral malperfusion syndrome secondary to AAAD. CTP parameters might be useful for predicting the postoperative neurological prognosis.