2024 Volume 53 Issue 5 Pages 274-277
Cerebral malperfusion is a serious complication of acute aortic dissection type A(AADA), and the best strategy for its management remains unclear. A 71-year-old woman was brought to our hospital because of consciousness disorder and right hemiplegia. Contrast-enhanced CT showed AADA and occlusion of the left common carotid artery. As the symptoms gradually improved and CT showed flow in the left distal carotid artery, we prioritized central repair by total arch replacement and Frozen Elephant Trunk with deep hypothermia and antegrade cerebral perfusion (ACP). Although the ACP cannula did not go into the left common carotid artery and we eventually had to do a left intra-carotid bypass, she was discharged home without any symptoms. It is acceptable that we give the priority to central repair over direct carotid artery re-perfusion when her symptoms improve. Besides we have to perform carotid bypass if the malperfusion is remains.
