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Endovascular Recanalization and Carotid Stenting: The New Approach to Restore Cerebral Perfusion during Aortic
Maxim Agarkov1, Kirill Kozlov2,3, Ekaterina Senkina4
1Interventional Radiology Gusev Central District Hospital, 56, Moskovskaya Str., Gusev, 238051 Kaliningrad Oblast, Russia.
Insights
Type A aortic dissection (TAAD) with cerebral malperfusion can be fatal. A new approach using endovascular recanalization and carotid stenting successfully restored cerebral perfusion in two patients, offering a potential life-saving treatment.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Interventional Radiology
Background:
- Type A aortic dissection (TAAD) presents diagnostic challenges due to overlapping symptoms with ischemic stroke, potentially leading to delayed or incorrect treatment.
- Cerebral malperfusion in TAAD can result in neurological deficits, and conventional treatments like thrombolysis may exacerbate the condition, increasing mortality and disability risks.
Purpose of the Study:
- To evaluate a novel endovascular approach for restoring cerebral perfusion in patients with Type A aortic dissection complicated by cerebral malperfusion.
- To assess the efficacy and safety of endovascular recanalization and carotid stenting as a treatment strategy for this critical condition.
Main Methods:
- The study presents two clinical cases of TAAD with cerebral malperfusion.
- One patient underwent transcatheter aortic valve implantation prior to the dissection event, while the other presented with severe hypertension and ischemia.
- Both patients were evaluated for neurological status, and surgical correction of the aortic dissection was deferred to address cerebral perfusion issues.
Main Results:
- Surgical correction for aortic dissection was deemed unsuitable in both cases.
- Cerebral perfusion was successfully restored rapidly in both patients through endovascular recanalization and carotid stenting.
- The intervention addressed acute bilateral internal carotid occlusion, a life-threatening complication of TAAD.
Conclusions:
- Acute bilateral internal carotid occlusion is a critical and potentially fatal complication of Type A aortic dissection.
- Emergency endovascular recanalization combined with carotid stenting presents a viable and potentially life-saving option for restoring cerebral perfusion in select TAAD patients.
Abstract:
A type A aortic dissection (TAAD) is a dangerous condition requiring emergency surgery. Due to the similarity of the symptoms of cerebral malperfusion in TAAD and the signs of ischemic stroke, a differential diagnosis of these diseases is not always available. Patients with TAAD after cerebral malperfusion can have a neurological deficit. Thrombolysis is performed in this case. It can worsen the patient's condition and increase the risk of mortality and disability. The aim of the study is to evaluate the new approach to restoring cerebral perfusion during aortic dissection. This approach includes endovascular recanalization and carotid stenting.
Methods:
Two clinical cases of TAAD complicated by cerebral malperfusion are described. The first patient is 73 years old and was admitted as planned to perform transcatheter aortic valve implantation (TAVI) for grade III aortic stenosis. The patient underwent transcatheter aortic valve implantation (TAVI) on the second day after admission. The second patient is 60 years old and was hospitalized by an ambulance with strong hypertension and ischemia. The surgical correction of aortic dissection was postponed until the neurological status assessment in both patients.
Results:
The surgery to correct the aorta dissection was deemed inappropriate. The carotid arteries have been reanalyzed, and cerebral perfusion has been restored in a short time in both patients.
Conclusion:
Acute bilateral internal carotid occlusion is a potentially fatal TAAD outcome. Emergency endovascular recanalization and carotid stenting may be considered one of the few ways to restore cerebral perfusion.
