INTRODUCTION
Stroke is a highly morbid complication of acute type A aortic dissection
(ATAAD) repair with reported incident rates of 10% to
30%.1-3 Factors related to stroke after ATAAD repair
including the selection of arterial cannulation site, brain protection
method, optimal temperature control, and range of replaced aorta had
been reported.2,4-14
Generally, malperfusion is diagnosed in patients who had clinical
symptoms as well as occlusion of the corresponding
arteries.15,16 In the brain, only patients with both
acute neurological symptoms and significant stenosis or obstruction in
the carotid arteries are defined as brain malperfusion. It is easy to
understand that postoperative stroke occurs in such patients. However,
there were many cases of postoperative stroke even in patients without
significant stenosis or occlusion of carotid artery and without
preoperative neurological symptoms. Stroke rate of ATAAD repair is
higher than that of true aortic arch aneurysm
repair.11,14,17,18 In the case of aortic dissection,
embolism due to atheroma seems to be less frequent than that in true
aneurysm, so dissection itself seems to be involved in the occurrence of
cerebral stroke. But the details of the mechanism of stroke after ATAAD
repair are still unclear. We have previously reported that a dissection
of supra-aortic vessels affected long-term outcome after ATAAD
repair.19 We hypothesized that a dissection of
supra-aortic vessels was also a risk factor for stroke after ATAAD
repair.