Harleen K. Sandhu, Kristofer M. Charlton-Ouw, Ali Sawal, Samuel S. Leake, Ali Azizzadeh, Anthony L. Estrera, Hazim J. Safi, Sheila M. Coogan
Dept. of Cardiothoracic and Vascular Surgery, University of Texas at Houston Medical School, Houston, TX.
OBJECTIVES: Many patients with acute Type A aortic dissection present with neurologic symptoms and have abnormal carotid duplex ultrasound (CDU) findings. We performed an analysis to determine the characteristics of CDU in acute Type A aortic dissection.
METHODS: A prospectively maintained aortic database was queried for consecutive patients who underwent repair of acute Type A aortic dissection between January 2002 and December 2011. Patients who had CDU during their hospitalization were reviewed. Analysis was performed to determine risk of pre- and post-operative stroke.
RESULTS: We repaired 288 acute Type A aortic dissection patients, of which 87 patients had CDU during their hospitalization. Of the 87 patients, 61 (70%) had findings consistent with proximal dissection. Abnormalities noted on CDU included dissection flap on B-mode imaging, a second pulsed waveform after the initial systolic upstroke, and a widened and jagged systolic peak (Figure 1). A dissection flap extending into the common carotid arteries was visualized in 18 (21%) patients and was associated with preoperative stroke in 4 (22%) compared with 7 (10%) in those without a visualized dissection flap (p=0.108). Overall, 20 of 288 (7%) patients had evidence of stroke at presentation.
CONCLUSIONS: Aortic dissection should be considered in the presence of certain abnormal carotid waveforms - even in the absence of a visualized dissection flap. Recognition of these abnormal waveform patterns may expedite accurate diagnosis.
AUTHOR DISCLOSURES: A. Azizzadeh: Nothing to disclose; K. M. Charlton-Ouw: Nothing to disclose; S. M. Coogan: Nothing to disclose; A. L. Estrera: Nothing to disclose; S. S. Leake: Nothing to disclose; H. J. Safi: Nothing to disclose; H. K. Sandhu: Nothing to disclose; A. Sawal: Nothing to disclose.
Carotid duplex ultrasound image of a patient with acute Type A aortic dissection.
Posted April 2013