Endovascular management of symptomatic cerebral malperfusion due to carotid dissection after type A aortic dissection repair
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Updated: May 28, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
R Casana1, V Tolva, A Robecchi Majnardi
1Vascular Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy.
Insights
Type A acute aortic dissection can cause stroke. Endovascular stenting successfully treated carotid artery occlusion after aortic dissection repair, improving patient outcomes and motor function.
Area of Science:
- Cardiovascular Surgery
- Endovascular Therapy
- Neurology
Background:
- Type A acute aortic dissection is a life-threatening condition.
- Supra-aortic trunk involvement complicates dissection, leading to stroke in 6-20% of cases.
- Postoperative neurological deficits, like "drop attacks," warrant thorough investigation.
Observation:
- A 66-year-old female presented with "drop attacks" post-ascending aorta composite repair for type A aortic dissection.
- Doppler ultrasound revealed an intimal flap occluding the right internal carotid artery.
Findings:
- Endovascular stenting from the carotid bifurcation to the internal carotid artery successfully excluded the intimal flap.
- This endovascular intervention resolved carotid malperfusion.
- Post-procedure, the patient experienced significant motor functional improvement, exceeding expectations.
Implications:
- Endovascular stenting is a safe and effective treatment for carotid artery malperfusion secondary to aortic dissection.
- Postoperative ultrasound monitoring of supra-aortic trunks is crucial for early detection of complications.
- Prompt endovascular intervention can lead to better neurological and functional outcomes in patients with aortic dissection.
Purpose:
Type A acute aortic dissection is a surgical emergency, and supra-aortic trunk involvement may be complicated by stroke in 6% to 20% of cases. A 66-year-old Caucasian female patient underwent a composite repair of the ascending aorta for type A aortic dissection. Postoperative period was complicated by episodes of "drop attack." Doppler ultrasound of supra-aortic trunks revealed an intimal flap occluding right internal carotid artery.
Technique:
Multiple stenting was performed from carotid bifurcation to internal carotid artery in order to exclude the dissection intimal flap. After endovascular procedure physiatrist considered that motor functional improvement was better than expected, and we support that endovascular resolution of carotid malperfusion led to a better outcome.
Conclusion:
According to other experience, endovascular procedure resulted as a safe and effective way. Moreover, ultrasound monitoring of supra-aortic trunks in postoperative period is recommended.
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