Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review

Jean-François Aita (1) , Thibault Agripnidis (1, 2, 3) , Benoit Testud (4) , Pierre-Antoine Barral (4) , Alexis Jacquier (4) , Anthony Reyre (1) , Ammar Alnuaimi (4) , Nadine Girard (1) , Farouk Tradi (2, 3, 4) , Paul Habert (2, 3, 4) , Vlad Gariboldi (4) , Frederic Collart (4) , Axel Bartoli (4) , Jean-François Hak (1, 2, 3)

1 Département de Radiologie [Hôpital de la Timone - APHM]
2 LIIE - Laboratoire d'Imagerie Interventionnelle Expérimentale
3 CERIMED - Centre Européen de Recherche en Imagerie médicale
4 TIMONE - Hôpital de la Timone [CHU - APHM]

In this study, we report our local experience of type A aortic dissections in patients with cerebral malperfusion treated with carotid stenting before or after aortic surgery, and present a systematic literature review on these patients treated either with carotid stenting (CS) before or after aortic surgery (AS) or with aortic and carotid surgery alone (ACS). We report on patients treated in our center with carotid stenting for brain hemodynamic injury of carotid origin caused by type A dissection since 2018, and a systematic review was conducted in PubMed for articles published from 1990 to 2021. Out of 5307 articles, 19 articles could be included with a total of 80 patients analyzed: 9 from our center, 29 patients from case reports, and 51 patients from two retrospective cohorts. In total, 8 patients were treated by stenting first, 72 by surgery first, and 7 by stenting after surgery. The mean age; initial NIHSS score; time from symptom onset to treatment; post-treatment clinical improvement; post-treatment clinical worsening; mortality rate; follow-up duration; and follow-up mRS were, respectively, for each group (local cohort, CS before AS, ACS, CS after AS): 71.2 ± 5.3 yo, 65.5 ± 11.0 yo; 65.3 ± 13.1 yo, 68.7 ± 5.8 yo; 4 ± 8.4, 11.3 ± 8.5, 14.3 ± 8.0, 0; 11.8 ± 14.3 h, 21 ± 39.3 h, 13.6 ± 17.8 h, 13 ± 17.2 h; 56%, 71%, 86%, 57%; 11%, 28%, 0%, 14%; 25%, 12.3%, 14%, 33%; 5.25 ± 2.9 months, 54 months, 6.8 ± 3.8 months, 14 ± 14.4 months; 1 ± 1; 0.25 ± 0.5, 1.3 ± 0.8, 0.68 ± 0.6. Preoperative carotid stenting for hemodynamic cerebral malperfusion by true lumen compression appears to be feasible, and could be effective and safe, although there is still a lack of evidence due to the absence of comparative statistical analysis. The literature, albeit growing, is still limited, and prospective comparative studies are needed.

Mots clés: Aortic; Brain; Malperfusion; Carotid; Stenting; Surgery; Dissection

Domaines: Sciences du Vivant [q-bio]

Jean-François Aita, Thibault Agripnidis, Benoit Testud, Pierre-Antoine Barral, Alexis Jacquier, et al.. Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review. Journal of Personalized Medicine, 2023, 13 (1), pp.58. ⟨10.3390/jpm13010058⟩. ⟨hal-03959847⟩