Stroke and common carotid artery dissection of aortic origin: A systematic review

Harleen Kaur Sandhu, The University of Texas School of Public Health


This systematic review was designed to examine the world literature documenting patients with common carotid artery dissections (CCAD) secondary to aortic dissection and the association with stroke. Acute proximal aortic dissection is the most common cause of death due to aortic reasons. Stroke is a dreaded complication of the extension of aortic dissection into the common carotid arteries. The management CCAD after or concomitant to acute aortic dissection is controversial. We searched the MEDLINE and EMBASE databases for published literature on CCAD secondary to aortic dissection using multiple interfaces, including Ovid: Medline, ProSearch, PubMed/PMC, Cochrane Library, Scopus, Google Scholar, and EBSCOhost search portals. All documented cases with at least a well-documented English abstract were extracted. Additionally, manual reference search was performed and quantitative studies published in peer-reviewed journals, the gray literature (refers to the body of literature with informally published scientific material like conference proceedings, letters and reports) and white papers were explored. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria were applied to all studies. Data was synthesized, analyzed and reported following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and Cochrane reviews guidelines. A total of 165 articles, presenting 374 individual patients, were selected for detailed assessment. Presentation of these patients varied over a wide spectrum of symptomatology and many a times went undetected. The main endpoints of interest included mortality and postoperative neurologic deficits. Thirty-two articles reported carotid artery interventions performed prior, concomitant, or after aortic repair. Overall reported stroke incidence after aortic repair was 19.13% and 5 year neurological event-free survival was 54.5%. Overall 5 year survival was 71.5%. We did not find enough evidence of survival difference in those who underwent intervention for CCAD when compared to those patients who did not. All evidence suggests the need for developing a high index of suspicion for recognition, timely diagnosis, and early repair of proximal aortic dissection to improve the prognosis of these high risk patients.

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Recommended Citation

Sandhu, Harleen Kaur, "Stroke and common carotid artery dissection of aortic origin: A systematic review" (2013). Texas Medical Center Dissertations (via ProQuest). AAI1552483.