Risk prediction of postoperative permanent stroke in acute type A aortic dissection patients with severe common carotid artery stenosis using brain CT perfusion.

Rationale and objectives: To explore the feasibility and predictive utility for neurological outcomes of brain computed tomography perfusion (CTP) for surgically treated acute type A aortic dissection patients with severe common carotid artery stenosis. Materials and methods: Consecutive acute type A aortic dissection patients with severe common carotid artery stenosis undergoing preoperative brain computed tomography perfusion and surgery at our center were examined in retrospect. Brain perfusion was assessed using parameters including cerebral blood flow, cerebral blood volume, mean transmit time, time to maximum, penumbra volume and infarct core volume. Univariable and multivariable regression analyses were performed to identify clinical and imaging predictors associated with postoperative permanent stroke. Results: Out of 44 patients included, 19 patients (43.2 %) presented with postoperative permanent stroke. Univariable analysis revealed that internal carotid artery dissection, cerebral blood flow of the affected side, cerebral blood volume of the affected side, and penumbra volume were implicated in postoperative permanent stroke. Multivariable analysis further showed that cerebral blood flow of the affected side was an independent indicator of a permanent stroke following surgery (odds ratio: 0.820, 95 % confidence interval: 0.684-0.982; p = 0.012). The area under the receiver operating characteristic curve was 0.867 (95 % confidence interval: 0.764-0.970), and the optimal cut-off value was 45.6mL/100 mL/min. Conclusion: Cerebral blood flow of the affected side was an independent indicator of permanent stroke following surgery in acute type A aortic dissection patients with severe common carotid artery stenosis. Brain CTP could be a helpful modality for quantitative evaluation of cerebral malperfusion and neurological prognostication.