title: Management and outcomes of carotid artery extension of aortic dissections.
abstract: Aortic dissection (AD) is the most common aortic catastrophe. Carotid artery dissection due to extension of AD (CAEAD) is one severe complication of this condition. Despite years of refinement in the techniques for repair of AD, the optimal management strategy for CAEAD remains yet to be described. We hypothesized that CAEAD eventually resolves on antiplatelet therapy with a low but not insignificant risk of cerebrovascular accident (CVA).
  
  
  
  This was a single-institution retrospective review of patients admitted with nontraumatic coincident aortic and carotid dissection between 2001 and 2013.
  
  
  
  CAEAD was present in 38 patients (24 men [53%]). The median age was 59.5 years (range, 25-85 years). A Stanford type A AD was diagnosed in 36 patients (95%). CVA or transient ischemic attack was identified in 11 patients (29%). Eight were potentially attributable to the carotid lesion. Two of these eight strokes resulted in death. Of the 11 CVAs and transient ischemic attacks, 8 were evident at presentation, 2 were diagnosed postoperatively during hospitalization, and 1 was diagnosed during early follow-up. Only one of these three postadmission strokes was attributable to the carotid lesion. Nonoperative management of aortic and carotid dissections was pursued in 9 patients (24%), 26 (68%) underwent open repair, and 4 (11%) had endovascular management of AD (2 thoracic endovascular aortic repair, 2 endovascular fenestrations), including 1 patient with a staged hybrid procedure (frozen elephant trunk). There were eight inpatient deaths (21%) and nine deaths in the follow-up period. Of the 30 patients who survived to discharge, 24 (80%) were managed with antiplatelet therapy. At a median follow-up of 14.5 months in 22 patients with follow-up computed tomography scans available, a minority of lesions had resolved, and only one CVA was reported.
  
  
  
  This study found that CAEAD was associated almost exclusively with type A AD, was typically unilateral, most often on the left, and usually persisted at follow-up. Many CAEAD patients presented with CVA and experienced significant early mortality. Notably, not all CVA events were attributable to the CAEAD. CVAs were not common after admission, and there appeared to be a low risk of new or subsequent stroke during follow-up with routine antiplatelet and antihypertensive therapy.
authors.affiliation: Division of Vascular Surgery, University of Maryland, Baltimore, Md.
authors.forename: Adriana
authors.initials: A
authors.lastname: Laser
authors.affiliation: Division of Vascular Surgery, University of Maryland, Baltimore, Md.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Drucker
authors.affiliation: Division of Vascular Surgery, University of Maryland, Baltimore, Md.
authors.forename: Donald G
authors.initials: DG
authors.lastname: Harris
authors.affiliation: Division of Vascular Surgery, University of Maryland, Baltimore, Md.
authors.forename: Tanya
authors.initials: T
authors.lastname: Flohr
authors.affiliation: Division of Vascular Surgery, University of Maryland, Baltimore, Md; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, Md.
authors.forename: Shahab
authors.initials: S
authors.lastname: Toursavadkohi
authors.affiliation: Division of Vascular Surgery, University of Maryland, Baltimore, Md; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, Md.
authors.forename: Rajabrata
authors.initials: R
authors.lastname: Sarkar
authors.affiliation: Center for Aortic Disease, University of Maryland Medical Center, Baltimore, Md; Division of Cardiothoracic Surgery, University of Maryland, Baltimore, Md.
authors.forename: Bradley
authors.initials: B
authors.lastname: Taylor
authors.affiliation: Division of Vascular Surgery, University of Maryland, Baltimore, Md; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, Md. Electronic address: rcrawford@smail.umaryland.edu.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Crawford
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015142:Baltimore; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors