AIM  To analyze the risk factors of preoperative acute ischemic stroke (AIS) in patients with acute type a aortic dissection (ATAAD) and to establish a nomogram model for predicting the risk of ischemic stroke.

METHODS Three hundred and twelve patients who were clinically diagnosed with ATAAD from March 2020 to April 2021 were included for this study. The patients were divided into two groups according to the presence or absence of preoperative acute ischemic stroke and the influencing factors related to AIS were collected, including clinical data and imaging data. Univariate and multivariate logistic regression analyses were used to screen the predictors related to preoperative AIS and a nomogram model was established.

RESULTS Among the 312 patients, 114 (36.5%) developed preoperative AIS. Logistic regression analysis showed that age (P<0.05), syncope (P<0.05), D-dimer (P<0.01), moderate and severe aortic insufficiency (P<0.05), diameter ratio of true lumen in ascending aorta <0.33 (P<0.05) and common carotid artery dissection (P<0.05) were independent risk factors for acute ischemic stroke. The ROC curve results showed that the area under the curve of the ROC model for predicting acute ischemic stroke before acute type A aortic dissection was 0.80 (95%CI: 0.75～0.85). The calibration curve showed that the observed values fit well with the predicted values.

CONCLUSION Age, syncope, D-dimer, moderate to severe aortic insufficiency, diameter ratio of true lumen in ascending aorta <0.33 and common carotid artery dissection are independent risk factors for preoperative AIS in ATAAD patients. The nomogram has good ability to distinguish and correct the prediction of preoperative AIS in ATAAD patients.