Emergency Operation for an Unconscious Patient Caused by Stanford Type A Acute Aortic Dissection with Occlusion of the Right Common Carotid Artery

(Department of Cardiovascular Surgery, Saitama Medical Center, Kawagoe, Japan)

Hideaki Yamabi Kazuhito Imanaka Takahiro Matsuoka
Mitsuhiro Kawata
A 65-year old unconscious man with left hemiplegia was found to have acute Stanford type A aortic dissection(AAD)and occlusion of the brachiocephalic and right carotid artery. He underwent emergency surgery. Before midline sternotomy, arterial cannulas were inserted into the femoral artery and the true lumen of the right carotid artery and were connected thorough a Y-shaped extracorporeal circulation circuit to restore the cerebral perfusion. During the aortic procedure, both arteries were used as arterial inflow sites.The patient regained consciousness 6 h later and was extubated on the next day. He suffered infarction of the right cerebral hemisphere, but neurologic deficits were totally resolved. He was given an ambulatory discharged 46 days later and has been reinstated in his former job 6 months after the operation. The indications for emergency surgery for AAD complicated by stroke or coma remains controversial. Especially soon after the onset, surgery may be applicable for such AAD patients if neurological deficits are not obviously irreversible.
  Jpn. J. Cardiovasc. Surg. 41:124-127(2012)

Keywords:Stanford type A aortic dissection, unconscious, cerebral malperfusion, carotid artery occlusion