Aortic repair following initial decompressive craniectomy for acute type A aortic dissection complicated with...

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Medicine

Background:

• Acute type A aortic dissection is a life-threatening condition.
• Cerebral malperfusion is a severe complication of aortic dissection.
• Hemorrhagic cerebral infarction presents a significant surgical challenge.

Purpose of the Study:

• To describe a case of acute type A aortic dissection with hemorrhagic cerebral infarction.
• To illustrate the management strategy involving initial decompressive craniectomy and delayed hemiarch replacement.
• To report the neurological and surgical outcomes.

Main Methods:

• Initial diagnosis of hemorrhagic cerebral infarction and subsequent identification of acute type A aortic dissection.
• Emergency decompressive craniectomy for neurological management.
• Medical stabilization for nine weeks.
• Elective hemiarch replacement surgery.

Main Results:

• The patient's neurological condition stabilized with medical treatment.
• Postoperative course after hemiarch replacement was uneventful.
• No new neurological deficits were observed.
• The patient achieved functional recovery, enabling daily conversations and hospital visits via wheelchair.

Conclusions:

• A staged approach involving initial decompressive craniectomy and delayed aortic repair can be effective for acute type A aortic dissection with severe cerebral complications.
• Early neurological stabilization is crucial for successful surgical outcomes.
• This case demonstrates the potential for significant neurological recovery after complex aortic dissection management.