A Analysis Of CNS Defect Resulted From Aortic Dissection And Application Of TCD In The Follow-up Study Of Cerebral

Objective This paper includes two parts:(1) To explore the clinical features of aortic dissection complicated with CNS defect so as to make correct treatment by analyzing patients who CNS defect was the first symptom of aortic dissection. (2) To investigate the clinical characteristics, causes, treatment and prevention of neurological complications by the follow-up study on patients who underwent covered stent graft implantation. At the same time, to evaluate the practical significance of TCD in the diagnosis of cerebral artery steal blood syndrome.Methods (1)A retrospective analysis had been made of 234 patients with aortic dissection diagnosed by CT/MRI in the 2nd of affiliated hospital of Kunming medical university from January 2003 to April 2010, the 234 clinical cases were divided into two groups:CNS defect group(n=66) and without CNS defect group(n=168). The difference on onset, clinical stages, clinical classification, clinical manifestations and imaging appearances were compared between the two groups. (2)To sum up and analyze 74 clinical cases with aortic dissection hospitalized in our hospital from January 2007 to October 2010, the 74 clinical cases were divided into three groups (cases lost to follow-up were not included in the statistics):nonoperative treatment group (n=23), surgical treatment group A (left subclavian artery was part/full sealed by covered stent, n=22), surgical treatment group B (left subclavian artery was not sealed by covered stent, n=9). The difference on sexes, stage, Stanford type classification, therapeutic effects, imaging appearances of TCD was compared among the three groups. Self-controlled clinical trial was performed in 15 patients with aortic dissection hospitalized in our hospital from October 2009 to October 2010. Before and after treatment, the difference on morbidity of neurological complications, imaging appearances of TCD were compared. All data were analyzed by software SPSS 11.5.Results (1)There was significant difference in Stanford type, misdiagnosis rate, mortality rate between CNS defect group and without CNS defect group(P<0.05) except sexes and staging of AD, which did not show statistic difference between the two groups(P>0.05).(2)There was significant difference in mortality rate, imaging appearances of TCD between nonoperative treatment group and surgical treatment group(P<0.05),but there was no statistic difference in imaging appearances of TCD between surgical treatment group A and surgical treatment group B(P>0.05).(3) In self-controlled clinical trial we found that there was significant difference in morbidity of neurological complications and imaging appearances of TCD(P<0.05).Conclusion Aortic dissections with CNS defect were predominantly Stanford A type, which misdiagnosis rate of first consultation and mortality rate was obvious higher than that without CNS defect. Compare with nonoperative treatment, surgical treatment for aortic dissection had a low mortality rate and a high morbidity rate of neurological complications, the most common neurological complication was subclavian artery steal blood syndrome. The occurrence of neurological complications was related to that left subclavian artery was part/full sealed by covered stent, was not related to that left subclavian artery was not sealed by covered stent or nonoperative treatment. Subclavian artery steal blood syndrome could not be all observed by TCD, several possible explanations for the association including:the establishment of extensive collateral circulation, the experience of operator, the sensitivity of instrument, et al.