Persistent dissection of carotid artery in patients operated on for type A acute aortic dissection—carotid ultrasound follow-up

1999 ◽  
Vol 70 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Tomasz Zieliński ◽  
Jolanta Wołkanin-Bartnik ◽  
Hanna Janaszek-Sitkowska ◽  
Andrzej Biederman ◽  
Dariusz Rynkun ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Carotid Ultrasound

scholarly journals Italian multicentre study on type A acute aortic dissection: a 33-year follow-up

2015 ◽  
Vol 49 (1) ◽  
pp. 125-131 ◽  
Author(s):  
Claudio F. Russo ◽  
Giovanni Mariscalco ◽  
Andrea Colli ◽  
Pasquale Santè ◽  
Francesco Nicolini ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Multicentre Study ◽  
Acute Aortic Dissection ◽  
Type A

scholarly journals Early Spontaneous Resolution of an Iatrogenic Acute Type A Aortic Dissection

Aorta ◽  
2016 ◽  
Vol 04 (06) ◽  
pp. 235-239
Author(s):  
Mohammad Zafar ◽  
Philip Pang ◽  
Glen Henry ◽  
Bulat Ziganshin ◽  
Maryann Tranquilli ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Type I ◽  
Acute Type ◽  
Computed Tomography Scan ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Tomography Scan

AbstractAcute aortic dissection is a rare but devastating complication during cardiac catheterization. We present the case of an elderly female who incurred a Stanford Type A/DeBakey Type I acute aortic dissection extending into the arch vessels and descending aorta likely occurring during right coronary artery engagement for angioplasty. The patient was treated successfully by immediately sealing the entrance of the dissection via the placement of a stent and anti-impulse therapy. Follow-up computed tomography scan showed complete resolution of the dissection within one month.

scholarly journals Aorto-carotid bypass for type A acute aortic dissection complicated with carotid artery occlusion: no touch until circulatory arrest

2020 ◽  
Vol 31 (2) ◽  
pp. 263-265
Author(s):  
Hideki Sasaki ◽  
Takashi Harada ◽  
Hiroshi Ishitoya ◽  
Osamu Sasaki
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Artery Bypass ◽  
Type A ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Left Hemiparesis ◽  
Coma Scale

Abstract The surgical management for type A acute aortic dissection complicated with carotid artery occlusion remains controversial. Between December 2012 and June 2017, 127 patients who presented with type A acute aortic dissection were operated on in our hospital. Of this group, nine (7.08%) patients had cerebral malperfusion due to carotid artery occlusion. The site of occlusion was innominate artery (n = 5) or right carotid artery (n = 4). Preoperative neurological symptoms were left hemiplegia (n = 1), left hemiparesis (n = 3) and seizure (n = 2). Preoperative consciousness level was Japan Coma Scale 2 (n = 6), 20 (n = 2), or 200 (n = 1). The procedure consisted of hemiarch replacement (n = 4) or total arch replacement (n = 5). Aorto-carotid bypass was performed in all patients under hypothermic circulatory arrest. The time from onset of symptoms to operating room was 7.2 ± 2.4 h. Hospital mortality was 0%. Left hemiplegia and left hemiparesis improved significantly. Japan Coma Scale was 0 in all patients at discharge. Overall survival at 24 months after operation was 100%. Aorto-carotid artery bypass for type A acute aortic dissection with carotid artery occlusion is the treatment of choice in these high-risk patients. Our strategy of ‘no touch until circulatory arrest’ may contribute to neurological improvement.

scholarly journals Sonographic features of carotid artery dissection due to extension of aortic dissection: a case report

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Christian Boßelmann ◽  
Sven Poli
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Point Of Care ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Carotid Ultrasound ◽  
Case Presentation ◽  
Retrosternal Pain ◽  
Hemodynamic Assessment

Abstract Background Carotid artery dissection due to extension of aortic dissection (CAEAD) is a severe complication of acute aortic dissection. The risk of ischemic stroke is increased. Early sonographic detection and repeat evaluation are necessary to guide clinical management. Case presentation A 58-year-old male patient presents with sudden, tearing retrosternal pain. Point-of-care carotid ultrasound is used to establish the diagnosis of CAEAD. We describe a number of sonographic features and compare ultrasound to other imaging modalities. Conclusions Bedside carotid ultrasound enables rapid, sensitive and safe hemodynamic assessment, especially in critically ill patients.

scholarly journals Surgical treatment of type A acute aortic dissection with cerebral malperfusion: a systematic review

2021 ◽  
Author(s):  
Changtian Wang ◽  
LEI ZHANG ◽  
tao li ◽  
Zhilong Xi ◽  
Haiwei Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Surgical Repair ◽  
Type A ◽  
Mortality And Morbidity ◽  
Medline Search ◽  
Cerebral Malperfusion

Purpose: Type A acute aortic dissection (TAAAD) complicated with cerebral malperfusion (CM) is a life-threatening condition associated with high mortality, poor outcomes, and the optimal surgical management remains controversial. The aim of this review was to report the current results of surgical interventions of these patients. Methods: A systematic review was performed using PubMed and MEDLINE search for cases underwent surgical repair for TAAAD with CM. Demographics, neurological symptom, the time from onset of symptoms to operation, operation data, mortality, neurological outcome, and follow-up were reviewed. Results: A total of 363 patients with mean age of 65.7±13 years underwent surgical repair for TAAAD with CM were identified in 12 retrospective studies. In-hospital mortality was 20.1%. Mean duration of follow-up was 40.1 ± 37.6 months. The involved supra-aortic branch vessels were RCCA (n=99), LCCA (n=25) , B-CCA (n=52), CCA (n=131), IA (n=19), and LSA (n=8). Time from onset of neurological symptoms to surgery was 13.3 hours. Antegrade and/or retrograde cerebral perfusion was applied. Postoperatively, improved, unchanged and worsened neurological status was occurred in 54.3%, 27.1%, and 8.5%, respectively in 199 patients. Conclusion: The outcomes of surgical treatment of TAAAD complicated with CM indicate acceptable early mortality and morbidity. It is reasonable to perform lifesaving surgery on these patients. Early central surgical repair and reperfusion of brain may improve the outcomes.

Abstract 19334: Management and Outcomes of Acute Retrograde Type A Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Foeke J Nauta ◽  
Joon Bum Kim ◽  
Himanshu J Patel ◽  
Mark D Peterson ◽  
Hans-Henning Eckstein ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Innominate Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Early Mortality ◽  
Long Term Results ◽  
Descending Aorta ◽  
International Registry

Background: Presentations and outcomes of acute aortic dissection (AD) with an entry tear in the ascending aorta may differ from retrograde dissection with an entry tear in the descending aorta. However, guidelines recommend urgent surgical repair for both entities. Methods and Results: All patients with AD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2014 were analyzed. We identified 99 patients (67 men; 63.2±14.0 years) with an entry tear in the descending aorta and retrograde extension into the arch or ascending aorta. Overall, independent predictors of retrograde type A AD were increasing age(OR 1.0; 95% CI, 1.0 to 1.0; P=0.004), history of cocaine abuse (OR 4.9; 95% CI, 1.7 to 13.6; P=0.003), back pain at presentation (OR 2.1; 95% CI, 1.3 to 3.3; P=0.002), and non-white race (OR 0.4; 95% CI, 0.2 to 0.6; P<0.001). During initial hospitalization, 44 of these patients were managed medically (MED), 33 with open surgery(SURG) and 22with endovascular therapy (ENDO). Patients in the SURG group presented with larger ascending aortic diameters than MED and ENDO patients (P=0.04). The majority of the MED (72.7%) and ENDO (86.4%) patients had AD extension confined to zone 1 (proximal arch, P<0.001), whereas most of the SURG patients (71.8%) presented with AD extension into zone 0 (proximal to the innominate artery, P<0.001). Early (30-day or in-hospital) mortality rates of the MED, SURG and ENDO groups were 9.1%, 18.2%, and 13.6%, respectively (P=0.51), with 5-year survival of 86.7%, 80.0%, and 90.9%, respectively (mean follow-up, 3.3 years, log rank P=0.67). A trend of favorable early mortality was observed in patients with retrograde extension till zone 1 (8.6%) versus into zone 0 (18.6%, P=0.14).Early mortality of patients with retrograde type A AD (12.9%) was lower than those with type A AD (20.0%, P=0.001), while 5-year survival was similar (86.8% and 89.5%, respectively, mean follow-up, 3.0 years, log rank P=0.96). Conclusion: There is a subset of patients with acute retrograde type A AD who can be managed non-operatively with acceptable short and long-term results. This implies that a selective approach may be reasonable, particularly among those with proximal extension limited to the arch distal to the innominate artery.

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