Abstract WP210: Urgent Detection of Acute Type A Aortic Dissection in Ischemic Stroke or TIA
Background and purpose: Urgent diagnosis of acute Stanford type A aortic dissection (AAD) in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) is sometimes challenging. Several markers such as systolic blood pressure (SBP) laterality, initial D-dimer level, mediastinal-width to chest-width (M/C) ratio on X-ray, common carotid artery (CCA) dissection on carotid ultrasonography and pericardial effusion on echocardiography are reported to be useful to identify AAD in AIS or TIA. We validated these findings using our prospective stroke registry (ClinicalTrials.gov: NCT02251665).
Methods: Consecutive AIS or TIA patients with AAD who were admitted to our institute within 4.5 h of onset from Jan 2007 to Dec 2014 were reviewed. They were compared with AIS or TIA patients without AAD who admitted within 4.5 h of onset from Jan 2014 to Dec 2014.
Results: We found 24 AIS/TIA patients with AAD (15 women, 75±12 y.o.), and 245 patients without AAD (86 women, 74±12 y.o.). As compared to patients without AAD, AAD patients had higher SBP laterality (30±20 mmHg vs. 10±9 mmHg, p<0.001), higher initial D-dimer level (median 1.0μg/ml, IQR 0.5-2.4μg/ml vs. median 38.1μg/ml, IQR 8.1-155.1μg/ml; p<0.001), and higher M/C ratio in the recumbent position (0.35±0.05 vs. 0.29±0.05, p<0.001), and more frequently had occlusion or the intimal flap of the proximal CCA (85% vs. 1%, p<0.001) and pericardial effusion (43% vs. 1%, p<0.001). Using receiver operating characteristic curve analysis, the cutoff of SBP laterality, D-dimer level and M/C ratio was 17 mmHg, 4.1μg and 0.32, respectively, with c-statistic of 0.84, 0.96 and 0.82, respectively. Sensitivity, specificity, positive predictive value and negative predictive value to identify AAD were as follows.
Conclusions: High D-dimer level can be the most reliable screening test of AAD in AIS or TIA patients. Proximal CCA occlusion or flap appears to be the most disease specific finding with acceptable sensitivity.
Author Disclosures: N. Tokuda: None. M. Koga: None. T. Ohara: None. K. Minatoya: None. Y. Tahara: None. M. Higashi: None. Y. Miyazaki: None. K. Kajimoto: None. S. Matsubara: None. K. Nagatsuka: None. K. Toyoda: None.
- © 2016 by American Heart Association, Inc.