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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Published on: October 20, 2017

Aortic arch replacement for recurrent cerebral embolization.

Gilead Lancaster¹, Constantinos J Lovoulos, Michael Moussouttas

¹Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06510, USA.

The Annals of Thoracic Surgery

|February 9, 2002

Summary

Surgical removal of aortic arch atheromas effectively stopped recurrent embolic strokes in a patient. This aortic arch repair offers a promising solution for preventing future cerebral vascular accidents.

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Area of Science:

Cardiovascular Surgery
Neurology
Vascular Medicine

Background:

Aortic arch atheromas are a potential source of cerebral emboli, leading to ischemic strokes.
The surgical management of aortic arch atheromas remains controversial due to associated risks.
Cerebral vascular accidents (CVAs) can result from atheromatous embolization from the aortic arch.

Observation:

A 58-year-old woman experienced recurrent CVAs attributed to large, mobile atheromas in the aortic arch and descending thoracic aorta.
Despite anticoagulation with warfarin (Coumadin) and aspirin, cerebrovascular events persisted, and atheromas grew.
Transcranial ultrasound confirmed recurrent cerebral microembolic events originating from the aortic atheromas.

Findings:

Surgical excision and replacement of the affected aortic arch segment with a Dacron graft successfully eliminated embolic signals.
Postoperatively, all cerebrovascular events ceased, and anticoagulation was discontinued.
The patient demonstrated significant neurological recovery and remained well at 1-year follow-up.

Implications:

Resection of mobile aortic arch atheromas is a viable and effective treatment for preventing recurrent embolic strokes.
Increased identification of aortic atheromas via transesophageal echocardiography may elevate the importance of surgical intervention.
This approach offers a potential future strategy for managing patients with atheroma-induced cerebrovascular disease.