Carotid Artery Stenting Before Aortic Repair for Acute Type A Aortic Dissection Complicated by Cerebral Malperfusion

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Interventions

Background:

• Acute type A aortic dissection (aTAAD) poses significant risks, particularly when complicated by cerebral malperfusion.
• Cerebral malperfusion in aTAAD often results from carotid artery involvement, leading to poor neurological outcomes.

Observation:

• Three patients with aTAAD presented with hemiparesis and altered consciousness due to unilateral carotid artery occlusion.
• These patients underwent successful carotid artery stenting prior to aortic repair to restore intracranial perfusion.

Findings:

• Post-stenting angiography demonstrated successful restoration of cerebral blood flow in all patients.
• Following carotid artery stenting, all patients underwent aortic repair and experienced complete neurological recovery without residual symptoms.

Implications:

• Preoperative carotid artery stenting may be a beneficial strategy for selected aTAAD patients with carotid artery occlusion and cerebral malperfusion.
• This approach could significantly improve neurological outcomes and reduce the incidence of stroke in this high-risk patient population.