Lethal thrombus in the carotid artery during operation for acute aortic dissection with cerebral malperfusion

Area of Science:

• Cardiovascular Surgery
• Neurosurgery
• Vascular Surgery

Background:

• Acute type A aortic dissection presents a critical surgical emergency.
• Cerebral malperfusion is a life-threatening complication requiring immediate intervention.
• Standard surgical approaches may be challenged by complex vascular obstructions.

Observation:

• A patient with acute type A aortic dissection and cerebral malperfusion had complete obstruction of the right carotid artery.
• A significant, fresh thrombus was observed flowing backward from the obstructed carotid artery.
• Initial cerebral perfusion was established via cannulation of the right carotid and left femoral arteries.

Findings:

• Successful removal of the retrograde thrombus from the carotid artery.
• Restoration of cerebral reperfusion using a Y-shaped extracorporeal circulation circuit connecting both cannulated arteries.
• Utilized both carotid and femoral arteries for arterial inflow during the subsequent aortic repair.

Implications:

• Carotid artery cannulation is a vital technique in managing complex aortic dissections with cerebral malperfusion.
• Prompt identification and removal of retrograde thrombi are essential to prevent postoperative neurological deficits.
• This approach highlights the adaptability of extracorporeal circulation in critical vascular scenarios.