Stanford A型急性主动脉夹层合并新发脑梗死的影像学特征及预后

目的分析Stanford A型急性主动脉夹层(AAD)合并新发脑梗死患者的临床资料与放射及超声等影像学特征,探讨梗死部位、体积与影像学特征及预后的相关性。资料与方法连续收集Stanford A型AAD合并新发脑梗死患者45例,分别根据CTA及超声检查主动脉弓分支是否累及(累及组32例、未累及组13例)及患者生存状况(存活19例、死亡18例、8例放弃治疗)进行分组,分析其基本资料及影像学特征,统计新发脑梗死的好发部位、梗死体积及与病死率的相关性。结果 AAD合并脑梗死者男性占77.8%(35/45),71.1%(32/45)的主动脉夹层累及主动脉弓分支血管,最常见于无名动脉(66.7%,30例)和右颈总动脉(53.3%,24例)。合并脑梗死者以多发病灶占73.3%(33/45),病灶体积(0.7±0.1)cm^3,最好发于基底节区(P<0.01)。主动脉弓分支累及组病死率高于未累及组[60.0%(15/25)比25.0%(3/12),P=0.046]。与存活组比较,死亡组梗死灶范围较大[(1.18±0.25)cm^3比(0.54±0.12)cm^3,P=0.014],梗死灶数目较多(4.40±0.53比3.00±0.33,P=0.025),额叶及基底节区梗死发生率较高(P<0.05)。结论 AAD合并脑梗死者夹层主动脉弓部分支累及率高,脑梗死好发于基底节区,累及主动脉弓部分支患者围术期病死率高于未累及患者。梗死范围越大,病灶数目越多,死亡风险越高。

Imaging Features and Prognosis of Stanford Type A Acute Aortic Dissection Combined with Fresh Cerebral Infarction

Purpose To analyze the clinical data and imaging features of radiography and ultrasound in Stanford type A acute aortic dissection(AAD) patients combined with fresh cerebral infarction, and to investigate the correlation between infarct area, volume and imaging features and prognosis. Materials and Methods Forty-five Stanford type A AAD patients with fresh cerebral infarction were enrolled. All patients were grouped according to CTA and involvement of aortic arch branches or not through ultrasound examination(32 in involvement group and 13 in uninvolved group) and survival status of patients(19 in survival group and 18 in death group, eight patients gave up treatment) to analyze general materials and imaging data. Correlations between predilection site, infarct volume of new cerebral infarction and mortality were statistically recorded. Results In AAD combined cerebral infarction, there were 77.8% male(35/45), 71.1%(32/45) aortic dissection involved branch vessels of aortic arch. The mostly common seen was on innominate arteries(66.7%, 30 cases) and right common carotid arteries(53.3%, 24 cases). There were 73.3%(33/45) dead patients combined cerebral infarction, mainly with multiple lesions, the average lesion volume was(0.7±0.1) cm^3 and it was preferable in the basal ganglion(P<0.01). The mortality in the aortic arch branch involved group was higher than that in the unaffected group [60.0%(15/25) vs. 25.0%(3/12), P=0.046]. Compared with survival group, range of infarct lesions in death group was greater [(1.18±0.25) cm^3 vs.(0.54±0.12) cm^3, P=0.014], number of infarct lesions was greater(4.40±0.53 vs. 3.00±0.33, P=0.025) and infarct occurrence rate in frontal lobe and basal ganglia region was higher(P<0.05). Conclusion Involvement rate of aortic dissection arches in AAD patients combined with cerebral infarction is high. Cerebral infarction is preferred in basal ganglia region, and the mortality of patients involved aortic arch in perioperative period is higher than that of uninvolved patients. The greater the infarct area is, the more the lesions, the higher risks death would be.