经导管主动脉瓣置入术中主动脉弓解剖是否影响卒中侧边性?

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2023-08-17 DOI:10.1155/2023/5563121

Caterina Campanella, K. Vitanova, M. Burri, H. Ruge, R. Lange, S. Voss

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Multislice computed tomography (MSCT) analysis was used to assess aortic arch anatomy, arch configuration (types I–III), arch tortuosity, and the determination of the take-off angles of the supraaortic arteries. Results. The final study cohort comprised 77 patients. Periprocedural ischemic stroke was left-sided in 66.2% of the patients (n = 51) and right-sided in 33.8% (n = 26) (p = 0.006). MSCT analysis revealed a standard aortic arch branching pattern in 70.1% (n = 54) and a common origin of the brachiocephalic and left common arteries (bovine arch anatomy) in 29.9% (n = 23) of the patients. There was no association between the anatomical variations of the aortic arch and stroke laterality \n \n \n \n p\n =\n 0.601\n \n \n \n . Frequency of arch configuration types was 15.6% (type I), 74.0% (type II), and 10.4% (type III). 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引用次数: 0

摘要

背景。目前的数据显示经脑主动脉瓣置换术(TAVR)后以左侧脑卒中为主，而不是右侧脑卒中。主动脉弓变异可能增加导管跟踪和操作过程中主要进入左脑循环的心栓子颗粒的可能性。的目标。我们试图分析主动脉弓解剖对TAVR患者脑卒中偏侧性(右vs左)的影响。方法。2007年6月至2022年8月期间，所有TAVR术后出现症状性、围手术期左侧或右侧缺血性卒中的患者均纳入本研究。采用多层螺旋计算机断层扫描(MSCT)分析评估主动脉弓解剖、弓形态(I-III型)、弓弯曲程度以及主动脉上动脉起飞角度的确定。结果。最后的研究队列包括77名患者。围手术期缺血性卒中患者中左侧占66.2% (n = 51)，右侧占33.8% (n = 26) (p = 0.006)。MSCT分析显示70.1% (n = 54)的患者有标准的主动脉弓分支模式，29.9% (n = 23)的患者有头臂动脉和左总动脉的共同起源(牛弓解剖)。主动脉弓的解剖变异与脑卒中偏侧性无相关性(p = 0.601)。弓型的频率分别为15.6% (I型)、74.0% (II型)和10.4% (III型)，不同弓型与围术期卒中侧边度无相关性(I型:p = 0.526, II型:p = 0.585, III型:p = 1.000)。主动脉弓弯曲和主动脉上动脉成角在左右卒中患者中也没有差异。结论。我们的数据增加了证据，表明接受TAVR的患者有显著的左半球卒中倾向。然而，在我们的队列中，MSCT分析并没有显示主动脉弓几何形状与卒中侧偏性之间的关联。

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Does Aortic Arch Anatomy Affect Stroke Laterality in Transcatheter Aortic Valve Implantation?

Background. Current data reveal a predominace of left as opposed to right-sided cerebral strokes after transcatether aortic valve replacement (TAVR). Aortic arch variations might raise the likelihood of cardioembolic particles entering predominantly the left cerebral circulation during catheter tracking and manipulation. Aim. We sought to analyse the impact of aortic arch anatomy on stroke laterality (right vs. left) in patients undergoing TAVR. Methods. All patients who developed a symptomatic, periprocedural left- or right-sided ischemic stroke after TAVR between June 2007 and August 2022 were included in this study. Multislice computed tomography (MSCT) analysis was used to assess aortic arch anatomy, arch configuration (types I–III), arch tortuosity, and the determination of the take-off angles of the supraaortic arteries. Results. The final study cohort comprised 77 patients. Periprocedural ischemic stroke was left-sided in 66.2% of the patients (n = 51) and right-sided in 33.8% (n = 26) (p = 0.006). MSCT analysis revealed a standard aortic arch branching pattern in 70.1% (n = 54) and a common origin of the brachiocephalic and left common arteries (bovine arch anatomy) in 29.9% (n = 23) of the patients. There was no association between the anatomical variations of the aortic arch and stroke laterality p = 0.601 . Frequency of arch configuration types was 15.6% (type I), 74.0% (type II), and 10.4% (type III). There was no correlation between the different types of configuration and the laterality of periprocedural stroke (type I: p = 0.526 , type II: p = 0.585 , and type III: p = 1.000 ). Aortic arch tortuosity and angulation of the supraaortic arteries did also not differ between right- and left-sided strokes. Conclusion. Our data add evidence that there is a significant propensity for left-hemispheric strokes in patients undergoing TAVR. However, MSCT analysis in our cohort did not reveal an association between aortic arch geometry and laterality of stroke.

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.