Guglielmi Valeria, Groeneveld Nina-Suzanne, Posthuma Laura, Groot Adrien E, Majoie Charles Blm, Talacua Hanna, Kaya Abdullah, Boekholdt S Matthijs, Planken R Nils, Roos Yvo Bwem, Coutinho Jonathan M
Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Eur Stroke J. 2020 Mar;5(1):56-62. doi: 10.1177/2396987319883713. Epub 2019 Oct 22.
Data on the incidence of acute aortic dissection in the code stroke population are scarce. We report estimated incidence, clinical manifestations, treatment and outcomes of patients with an acute aortic dissection in a code stroke cohort from a comprehensive stroke centre.
We used data from a single-centre prospective registry of consecutive adult patients who presented to the emergency department between 2015 and 2018 with neurological deficits suggestive of an acute stroke ('code stroke'). All patients routinely underwent non-contrast computed tomography of the brain and computed tomography-angiography of the aortic arch, cervical and intracranial arteries.
Of 2874 code stroke patients, 1563 (54.4%) had acute ischaemia (ischaemic stroke or transient ischaemic attack). Fifteen patients (0.5% of code stroke patients and 0.8% of patients with acute ischaemia) had an acute aortic dissection (all Stanford classification type A). Discerning clinical manifestations were decreased consciousness in 11/15 (73%), pain in 8/15 (53%) and low systolic blood pressure (mean 106 mmHg, SD30). Acute aortic dissection was an incidental finding during computed tomography-angiography in 4/15 (27%). Two out of 15 patients (13%) received intravenous thrombolysis, 9/15 (60%) underwent aortic surgery and 10/15 (67%) died. Of those who survived, 3/5 (60%) had a good functional outcome (modified Rankin Scale 0-2).
In our comprehensive stroke centre, about 1/200 code stroke patients and 1/125 patients with acute ischaemia had an acute aortic dissection. Multicentre studies are necessary to acquire a more reliable estimate of the incidence of acute aortic dissection in the code stroke population. Given the ramifications of missing this diagnosis, imaging of the entire aortic arch is important in these patients.
关于卒中编码人群中急性主动脉夹层发病率的数据很少。我们报告了一家综合卒中中心卒中编码队列中急性主动脉夹层患者的估计发病率、临床表现、治疗及转归。
我们使用了来自单中心前瞻性登记处的数据，该登记处纳入了2015年至2018年间因提示急性卒中（“卒中编码”）的神经功能缺损而就诊于急诊科的连续成年患者。所有患者均常规接受脑部非增强计算机断层扫描以及主动脉弓、颈部和颅内动脉的计算机断层血管造影。
在2874例卒中编码患者中，1563例（54.4%）患有急性缺血性疾病（缺血性卒中或短暂性脑缺血发作）。15例患者（占卒中编码患者的0.5%，急性缺血性疾病患者的0.8%）发生了急性主动脉夹层（均为斯坦福A型）。有鉴别意义的临床表现为11/15（73%）患者意识下降，8/15（53%）患者疼痛，收缩压较低（平均106mmHg，标准差30）。4/15（27%）患者的急性主动脉夹层是在计算机断层血管造影时偶然发现的。15例患者中有2例（13%）接受了静脉溶栓治疗，9/15（60%）接受了主动脉手术，且10/15（67%）死亡。存活患者中，3/5（60%）功能转归良好（改良Rankin量表评分0 - 2分）。
在我们的综合卒中中心，约1/200的卒中编码患者和1/125的急性缺血性疾病患者发生了急性主动脉夹层。需要开展多中心研究以获得关于卒中编码人群中急性主动脉夹层发病率更可靠的估计。鉴于漏诊这一疾病的后果，对这些患者进行整个主动脉弓的成像检查很重要。
