Carotid artery bypass and supraclavicular subclavian artery cannulation for cerebral malperfusion in aortic dissection.
Étienne Fasolt Richard Corvin Meinert, Rawa Arif, Matthias Karck et al.
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Case in brief
A patient with acute type A aortic dissection extending from the aortic root to the right common femoral artery presented with cerebral malperfusion. Imaging showed occlusion of the right common carotid artery and dissection of the left common carotid artery. Treatment involved David’s procedure, arch repair with frozen elephant trunk implantation, bilateral extended carotid artery bypass, and extended left subclavian artery bypass. The patient was successfully treated.
What made this case unusual
Both common carotid arteries were compromised in different ways—one occluded and the other dissected—prompting bilateral extended carotid bypass as part of extensive aortic repair.
Diagnostic / clinical pearl
In acute type A dissection with cerebral malperfusion, assess the carotid arteries for occlusion or dissection; these findings may inform a repair that includes extended carotid bypass.