Association between aortic low-attenuation plaques and the risk of cerebral infarction in hybrid aortic arch repair.

Objectives: This study aimed to evaluate the association between aortic low-attenuation plaque (LAP) and the risk of cerebral infarctions, including microemboli, during hybrid aortic arch repair.

Methods: Between January 2016 and February 2023, 149 patients underwent hybrid aortic arch repair. Patients were excluded if they lacked preoperative or postoperative magnetic resonance imaging (MRI), had insufficient computed tomography (CT) data, a history of arch replacement or Kommerell's diverticulum. The LAP area (CT values: 0-60 Hounsfield unit) was measured in the total and the greater curvature area of aorta. The LAP area was categorized as large or small based on the median value. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for new cerebral infarction lesions (NCILs).

Results: Eighty-four patients were evaluated for NCILs using both pre- and postoperative MRI (NCIL positive: 41 patients, NCIL negative: 43 patients). The NCIL-positive group had a higher proportion of zone 0 landing (46% versus 21%; P = 0.020), greater use of the chimney graft technique (20% versus 5%; P = 0.046) and a larger LAP area in the greater curvature of the aortic arch (27 mm2 versus 13 mm2; P < 0.001). Multivariable-adjusted logistic regression model showed a large LAP area in the greater curvature of the aortic arch significantly increased the risk of NCILs (OR 5.23, 95% CI 1.29-18.34).

Conclusions: A large LAP area in the greater curvature of the aortic arch is independently associated with an increased risk of NCILs during hybrid aortic arch repair.