# Cerebral malperfusion resolution after repair of acute DeBakey type I dissection with a novel hybrid prosthesis: early results of the PERSEVERE Study

## TL;DR

A new hybrid prosthesis improved neurological outcomes in patients with aortic dissection and cerebral malperfusion.

## Contribution

The study introduces a novel hybrid prosthesis that may enhance neurological recovery in high-risk aortic dissection patients.

## Key findings

- Most patients with cerebral malperfusion showed resolution or stability of symptoms after surgery.
- Radiographic indicators of malperfusion improved significantly post-surgery.

## Abstract

Patients undergoing hemiarch repair for acute DeBakey type I dissection (ADTI) are high risk for postoperative stroke, especially if cerebral malperfusion is present preoperatively. We sought to evaluate whether the AMDS Hybrid Prosthesis (AMDS), a bare metal stent designed to promote positive aortic remodelling and prevent distal anastomotic new entry tears, may improve neurological outcomes of patients with ADTI presenting with cerebral malperfusion.

PERSEVERE enrolled patients presenting with ADTI and malperfusion at 26 sites in North America. Among 93 enrolled patients, 30 (32.3%) presented with cerebral malperfusion. We evaluated for resolution of clinical and/or radiological cerebral malperfusion after hemiarch repair with AMDS.

Cerebral malperfusion was diagnosed clinically in 19 (63.3%) patients and radiographically in 23 (76.7%) patients. Among the patients with clinical cerebral malperfusion, 18 survived the perioperative period; of these, 11 (61%) experienced complete resolution of preoperative symptoms, 5 (28%) had no worsening of preoperative symptoms, and 2 (11%) had a new disabling stroke postoperatively. At follow-up, the mean true lumen to total arterial diameter ratio (measured by computed tomography angiography) improved from 30.9% to 64.4% (P = 0.002) in the innominate artery and 33.8% to 60.6% (P = 0.005) in the left common carotid artery from preoperative baseline in patients with radiographic cerebral malperfusion.

Among patients presenting with ADTI and cerebral malperfusion, the majority had resolution or stability of neurological symptoms after hemiarch repair using the AMDS. Radiographic indicators of malperfusion also improved.

https://clinicaltrials.gov/study/NCT05174767

Among patients with acute DeBakey type I dissection (ADTI), those presenting with preoperative malperfusion have increased risks of morbidity and mortality [1].