Related Experiment Video
Updated: Jun 12, 2026

Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Pyramidal Angulation of the Ascending Aortic Graft: Recurrent Emboli After Type A Repair
Naomi Timmermans1, Kayan Lam2, Pieter-Jan Vlaar2
1Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Background:
We report a unique case of recurrent cerebrovascular events under adequate anticoagulation, in the absence of a visible thrombus, due to a severely kinked ascending aortic graft after type A dissection repair.
Case Summary:
A 70-year-old man developed 4 transient ischemic attacks and 3 ischemic strokes over 4 years despite therapeutic rivaroxaban levels and prior antiplatelet therapy. Imaging revealed a kinked ascending graft without thrombus. High-risk redo surgery was pursued to correct graft geometry, after which no further embolic events occurred during early follow-up (5 months).
Discussion:
This case addresses the clinical dilemma whether a visible thrombus is required to justify redo surgery after type A repair, especially when recurrent embolism occurs under maximal medical therapy.
Take-Home Message:
Surgical correction of graft kinking may be indicated-even in the absence of a thrombus-when embolic risk persists under optimal anticoagulation.
Related Concept Videos
Aneurysm III: Interprofessional Care
Aortic Regurgitation I: Introduction
Aneurysm IV: Nursing Management
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Aortic Regurgitation III: Medical Management
Aneurysm I: Introduction

