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\begin{document}

\title{Neuroanatomy and Severity of Stroke in Patients with Type A Aortic
Dissection}



\author[1]{Akash Fichadiya}%
\author[1]{Bijoy Menon}%
\author[1]{Alex Gregory}%
\author[1]{Ericka Teleg}%
\author[1]{Jehangir Appoo}%
\affil[1]{University of Calgary Cumming School of Medicine}%


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  \date{June 08, 2024}


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\begin{abstract}
Background: Strokes are a known complication of acute type A aortic
dissection (ATAAD) repair. Understanding the neuroanatomy, mechanism,
and severity of stroke will facilitate efforts to improve prediction,
prevention, and treatment strategies. Methods: Retrospective review of
patients who sustained stroke from a consecutive series of patients
undergoing ATAAD repair. Neuroimaging was interpreted by two stroke
neurologists blinded to clinical results. Severity of stroke was
assessed by National Institutes of Health Stroke Scale (NIHSS). Residual
disability at thirty days was assessed using the modified Rankin Scale
(mRS). Results: Twenty percent (38/189) of patients undergoing repair
for ATAAD had stroke {[}unilateral 58\%, bi-hemispheric 42\%
(p=0.33){]}. All strokes were ischemic. No significant lateralization
(right vs. left) was noted with unilateral strokes (26\% vs 32\%,
p=0.67). Etiology of stroke was embolic (58\%), hypoperfusion (26\%),
mixed (11\%) and unknown (5\%). There were no intraoperative variables
that correlated with the neuroanatomy or mechanism of stroke.
Pre-operative carotid dissection was seen in 40\% (n=15), while
postoperatively 10\% (n=4) sustained intracranial large vessel occlusion
(LVO). Strokes were moderate or severe (NIHSS [?] 9) in 97\% of cases,
with 66\% incidence of moderate residual disability (mRS [?] 3) at one
month postoperatively. Conclusions: Stroke associated with ATAAD is
heterogeneous in etiology and location. Most strokes are severe on
detection and result in significant residual disability. One in 10
strokes are due to LVO amenable to endovascular treatment. Future trials
may evaluate the role for early neuroimaging and treatment of incident
stroke given modern advancements in endovascular stroke therapy.%
\end{abstract}%



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