Preoperative percutaneous carotid artery recanalization in a patient with aortic dissection type A

Management of patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion due to carotid artery obstruction is still a major challenge and often associated with poor prognosis despite successful surgical aortic repair, due to prolonged cerebral perfusion deficit. Here, we present the first report regarding successful percutaneous recanalization of an internal carotid artery occlusion in the setting of an ATAAD prior to open surgical aortic repair with excellent clinical outcome after three year follow-up, including almost full neurological recovery.

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Extra-anatomic revascularization for preoperative cerebral malperfusion due to distal carotid artery occlusion in acute type A aortic dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezv064 ◽

2015 ◽

Vol 49 (2) ◽

pp. 652-659 ◽

Cited By ~ 13

Author(s):

Maximilian Luehr ◽

Christian D. Etz ◽

Michal Nozdrzykowski ◽

Lukas Lehmkuhl ◽

Martin Misfeld ◽

...

Keyword(s):

Carotid Artery ◽

Aortic Dissection ◽

Type A ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Acute Type ◽

Type A Aortic Dissection ◽

Cerebral Malperfusion

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Common Carotid Artery Occlusion Secondary to Type A Aortic Dissection

10.1055/s-0039-1678943 ◽

2019 ◽

Author(s):

M. Kreibich ◽

N. Desai ◽

J. Bavaria ◽

H. Okamura ◽

N. Kimura ◽

...

Keyword(s):

Carotid Artery ◽

Aortic Dissection ◽

Common Carotid Artery ◽

Type A ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Type A Aortic Dissection ◽

Common Carotid Artery Occlusion

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

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa092 ◽

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.

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Type A aortic dissection: involvement of carotid artery and impact on cerebral malperfusion

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320984329 ◽

2020 ◽

pp. 021849232098432

Author(s):

Wahaj Munir ◽

Jun Heng Chong ◽

Amer Harky ◽

Mohamad Bashir ◽

Benjamin Adams

Keyword(s):

Carotid Artery ◽

Aortic Dissection ◽

Type A ◽

Current Evidence ◽

Management Approach ◽

Complex Nature ◽

Acute Type ◽

Type A Aortic Dissection ◽

Cerebral Malperfusion ◽

The Impact

Acute type A aortic dissection is a surgical emergency and management of such pathology can be complex with poor outcomes when there is organ malperfusion. Carotid artery involvement is present in 30% of patients diagnosed with acute type A aortic dissection, and given its emergency and complex nature, there is much controversy regarding the approach, extent of treatment, and timing of the intervention. It is clear that the occurrence of cerebral malperfusion adds an extra layer of complexity to the decision-making framework for treatment. Standardization and validation of the optimal management approach is required, and this should ideally be addressed with large-scale studies. Nonetheless, current literature supports the need for rapid recognition and diagnosis of acute type A aortic dissection with cerebral malperfusion, immediate and extensive surgical repair, and the appropriate use of cerebral perfusion techniques. This paper aims to discuss the current evidence regarding the impact of carotid artery involvement in both the management and outcomes of acute type A aortic dissection.

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