Management of compromised bilateral carotid artery flow in acute type A aortic dissection, in a neurologically intact...

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Type A aortic dissection (TAAD) is a life-threatening condition necessitating prompt surgical intervention.
• Cerebral malperfusion complicates TAAD in 6-14% of cases, often due to dissection flap obstruction of arch vessels or embolic events.
• Current literature lacks consistent management protocols for concurrent carotid artery dissection in TAAD patients.

Observation:

• This case report focuses on a neurologically intact patient with TAAD and bilateral carotid artery involvement.
• The described strategy aims to manage carotid artery issues within TAAD repair without resorting to total circulatory arrest (TCA).

Findings:

• The presented easily replicable strategy successfully managed bilateral carotid artery involvement in TAAD.
• The patient experienced a good neurological outcome, demonstrating the efficacy of the approach.
• Avoidance of total circulatory arrest (TCA) was achieved during the intervention.

Implications:

• This case suggests a viable and potentially safer alternative for managing complex TAAD cases involving carotid arteries.
• The findings may contribute to developing standardized protocols for TAAD with concomitant carotid dissection.
• This approach could improve neurological outcomes and reduce the risks associated with TCA in select TAAD patients.