INTRODUCTION
Stroke is a highly morbid complication of acute type A aortic dissection (ATAAD) repair with reported incident rates of 10% to 30%.1-3 Factors related to stroke after ATAAD repair including the selection of arterial cannulation site, brain protection method, optimal temperature control, and range of replaced aorta had been reported.2,4-14
Generally, malperfusion is diagnosed in patients who had clinical symptoms as well as occlusion of the corresponding arteries.15,16 In the brain, only patients with both acute neurological symptoms and significant stenosis or obstruction in the carotid arteries are defined as brain malperfusion. It is easy to understand that postoperative stroke occurs in such patients. However, there were many cases of postoperative stroke even in patients without significant stenosis or occlusion of carotid artery and without preoperative neurological symptoms. Stroke rate of ATAAD repair is higher than that of true aortic arch aneurysm repair.11,14,17,18 In the case of aortic dissection, embolism due to atheroma seems to be less frequent than that in true aneurysm, so dissection itself seems to be involved in the occurrence of cerebral stroke. But the details of the mechanism of stroke after ATAAD repair are still unclear. We have previously reported that a dissection of supra-aortic vessels affected long-term outcome after ATAAD repair.19 We hypothesized that a dissection of supra-aortic vessels was also a risk factor for stroke after ATAAD repair.