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Repeated brain infarction caused by atherosclerosis of the bovine aortic arch successfully treated with arch
Tae Yamashita1, Hisaya Hiramatsu, Naoki Washiyama
1Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka.
Insights
A patient with a bovine aortic arch experienced recurrent embolic infarction. Surgical aortic arch replacement successfully prevented further ischemic events, highlighting its importance for complex aortic arch disease.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Neurology
Background:
- Recurrent embolic infarction poses a significant clinical challenge.
- Anatomical variations like bovine aortic arch can complicate cerebrovascular disease management.
Observation:
- A 62-year-old man presented with a history of repeated embolic infarctions.
- Computed tomography angiography revealed a bovine aortic arch with significant stenosis in the innominate and left carotid arteries.
Findings:
- Standard antiplatelet therapy failed to prevent recurrent ischemic events.
- Surgical aortic arch replacement was performed, leading to complete resolution of embolic events.
Implications:
- Surgical aortic arch replacement is a viable and effective treatment for complex atherosclerotic lesions in patients with bovine aortic arch.
- Endovascular approaches may carry higher risks in these specific anatomical configurations.
- This case underscores the importance of considering surgical intervention for complex aortic arch pathologies to prevent stroke.
Abstract:
A 62-year-old man presented with repeated embolic infarction over the last 3 years. Computed tomography angiography of the aortic arch revealed that the patient had a common trunk for the innominate and left carotid arteries, the so-called bovine aortic arch, with stenosis extending to both the left common carotid artery and innominate artery. Since antiplatelet therapy was not adequate for prevention of recurrent infarction, total replacement of the aortic arch was performed. Since then, no further ischemic events have manifested. Endovascular procedures are not safe enough for atherosclerotic lesions in the aortic arch, especially in a patient with bovine aortic arch, so surgical aortic arch replacement should be considered.
