Case report: Multi-site perfusion strategy for type A acute aortic dissection complicated with cerebral malperfusion

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Acute type A aortic dissection (aTAAD) poses significant risks, especially when presenting with cerebral malperfusion.
• Cerebral malperfusion in aTAAD often involves complex vascular issues, complicating surgical candidacy and treatment.
• High morbidity and mortality rates are associated with aTAAD complicated by neurological deficits.

Observation:

• A 48-year-old male presented with paraplegia and decreased consciousness due to acute type A aortic dissection.
• Computed Tomography revealed complete occlusion of both common carotid arteries in the affected patient.
• The patient's complex presentation included severe neurological compromise and extensive aortic pathology.

Findings:

• Successful treatment was achieved using a multi-site perfusion strategy combined with a Hybrid Frozen Elephant Trunk graft.
• This approach rapidly restored cerebral blood flow, mitigating ischemic brain injury.
• The surgical intervention addressed both the aortic dissection and the critical cerebral vessel occlusion.

Implications:

• Aggressive aortic arch and neck vessel reconstruction, supported by multi-site perfusion, can be a viable strategy for selected aTAAD patients.
• This case highlights the potential for improved mortality and neurological outcomes in complex aTAAD cases.
• The presented technique offers a promising option for managing life-threatening cerebral malperfusion in acute aortic dissections.