Thrombectomy and reconstruction of the left vertebral artery after total arch replacement: never give up on...

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• A 64-year-old male patient presented with multiple cardiovascular conditions including aortic regurgitation, ischemic heart disease, and complex aortic aneurysms (transverse aortic and abdominal-common iliac).
• The patient underwent successful complex concomitant cardiovascular surgeries: aortic valve replacement, coronary artery bypass grafting, and total aortic arch replacement using the elephant trunk technique.

Observation:

• Postoperatively, on the 5th day, the patient developed cardiac tamponade.
• This complication led to bulbar palsy, a neurological deficit, caused by occlusion of the dominant left vertebral artery.

Findings:

• A thrombectomy of the occluded left vertebral artery was performed.
• The vertebral artery was successfully reconstructed using a saphenous vein graft.
• Following the intervention, the patient experienced significant improvement in neurological symptoms.

Implications:

• This case highlights the potential for neurological recovery through revascularization in patients experiencing ischemic stroke post-cardiovascular surgery.
• It suggests that timely intervention for vertebral artery occlusion can be beneficial even after extensive cardiac and aortic procedures.