scholarly journals Carotid artery cannulation in acute aortic dissection with malperfusion

2006 ◽  
Vol 131 (6) ◽  
pp. 1398-1399 ◽  
Author(s):  
Paul P. Urbanski
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Artery Cannulation

Successful carotid artery stenting in patients with aortic dissection

2020 ◽  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Aortic Dissection ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Aortic Arch ◽  
Common Carotid Artery ◽  
Carotid Artery Stenting ◽  
Acute Aortic Dissection ◽  
Optimal Timing

Background: There are no guidelines for the optimal timing of surgery (emergency vs. delayed) for ascending aortic dissection with acute ischemic stroke. We retrospectively compared the prognoses and radiological and clinical findings for concomitant aortic dissection and ischemic stroke in a series of case reports. Case presentation: Three patients presented with left hemiparesis. Patient 1 underwent surgery for acute aortic dissection without treatment for acute ischemic stroke. In Patient 2, emergency stenting could not be performed due to cardiac tamponade and hypotension. Therefore, emergency acute aortic dissection surgery was performed. Patient 3 underwent emergency right common carotid artery stenting followed by surgery for acute aortic dissection. Brain perfusion computed tomography angiography (CTA) was performed to diagnose severe stenosis of the right common carotid artery or occlusion concomitant with acute aortic dissection involving the aortic arch with a cerebral perfusion mismatch in all the patients. Patient 3 had postoperative local cerebral infarction, whereas patients 1 and 2 (without stent insertion) had extensive postoperative cerebral infarction. Conclusion: Patient 3 showed a better prognosis than patients without stent treatment. We suggest that perfusion CTA of the aortic arch in suspected acute ischemic stroke can facilitate early diagnosis and prompt treatment in similar patients.

Epiaortic Ultrasound-Guided True Lumen Cannulation of Ascending Aorta in Acute Aortic Dissection Type A

2021 ◽  
Vol 104 (4) ◽  
pp. 604-609
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Axillary Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Ultrasound Guided ◽  
True Lumen ◽  
Artery Cannulation ◽  
Aortic Cannulation ◽  
Aortic Dissection Type A

Background: The choice of arterial inflow for acute Stanford type A aortic dissection repair remains controversial. The axillary artery should be considered as first choice for cannulation, but this technique is time-consuming. The ascending aortic cannulation provides antegrade perfusion and can be performed rapidly but there are several concerns such as aortic rupture, extension of dissection, and false lumen cannulation. Objective: To compare the establishment time of cardiopulmonary bypass (CPB) and postoperative outcomes of the two cannulation techniques that provide antegrade perfusion, which was direct true lumen cannulation on the dissected ascending aorta using epiaortic ultrasound-guided and axillary artery cannulation in Siriraj Hospital. Materials and Methods: The authors retrospectively reviewed all the 30 cases of acute aortic dissection type A using two different cannulation methods performed between February 2011 and May 2017. Direct true lumen ascending aortic cannulation was performed using the epiaortic ultrasound-guide with Seldinger technique in 12 patients, and axillary artery cannulation was performed in 18 patients. Results: The direct true lumen ascending aortic cannulation was safely performed in all patients. None of them had aortic rupture. Skin incision to CPB time was significantly faster in the epiaortic ultrasound-guided ascending aortic cannulation group at 29±8 versus 49±14 minutes (p<0.001). The 30-day mortality and postoperative adverse events, such as ischemic stroke, acute kidney injury, visceral organ and limb malperfusion showed no statistically significant difference from the axillary artery cannulation method. Conclusion: Epiaortic ultrasound-guided true lumen cannulation of ascending aorta in the treatment of acute aortic dissection type A is safe and feasible. Skin incision to CPB time can be performed faster and provided good outcome compared to the axillary artery cannulation technique. Keywords: Acute aortic dissection, Ascending cannulation, Epiaortic ultrasound

scholarly journals Monocyte Subsets, Stanford-A Acute Aortic Dissection, and Carotid Artery Stenosis: New Evidences

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Noemi Cifani ◽  
Maria Proietta ◽  
Maurizio Taurino ◽  
Luigi Tritapepe ◽  
Flavia Del Porto
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Carotid Artery Stenosis ◽  
Acute Aortic Dissection ◽  
Group Versus ◽  
Artery Stenosis ◽  
Monocyte Subset ◽  
Monocyte Subsets ◽  
Cd4 Lymphocyte ◽  
Classical Monocytes

Monocytes are a heterogeneous cell population distinguished into three subsets with distinctive phenotypic and functional properties: “classical” (CD14++CD16-), “intermediate” (CD14++CD16+), and “nonclassical” (CD14+CD16++). Monocyte subsets play a pivotal role in many inflammatory systemic diseases including atherosclerosis (ATS). Only a low number of studies evaluated monocyte behavior in patients affected by cardiovascular diseases, and data about their role in acute aortic dissection (AAD) are lacking. Thus, the aim of this study was to investigate CD14++CD16-, CD14++CD16+, and CD14+CD16++ cells in patients with Stanford-A AAD and in patients with carotid artery stenosis (CAS).Methods. 20 patients with carotid artery stenosis (CAS group), 17 patients with Stanford-A AAD (AAD group), and 17 subjects with traditional cardiovascular risk factors (RF group) were enrolled. Monocyte subset frequency was determined by flow cytometry.Results. Classical monocytes were significantly increased in the AAD group versus CAS and RF groups, whereas intermediate monocytes were significantly decreased in the AAD group versus CAS and RF groups.Conclusions. Results of this study identify in AAD patients a peculiar monocyte array that can partly explain depletion of T CD4+ lymphocyte subpopulations observed in patients affected by AAD.

scholarly journals Aorto-carotid bypass for type A acute aortic dissection complicated with carotid artery occlusion: no touch until circulatory arrest

2020 ◽  
Vol 31 (2) ◽  
pp. 263-265
Author(s):  
Hideki Sasaki ◽  
Takashi Harada ◽  
Hiroshi Ishitoya ◽  
Osamu Sasaki
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Artery Bypass ◽  
Type A ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Left Hemiparesis ◽  
Coma Scale

Abstract The surgical management for type A acute aortic dissection complicated with carotid artery occlusion remains controversial. Between December 2012 and June 2017, 127 patients who presented with type A acute aortic dissection were operated on in our hospital. Of this group, nine (7.08%) patients had cerebral malperfusion due to carotid artery occlusion. The site of occlusion was innominate artery (n = 5) or right carotid artery (n = 4). Preoperative neurological symptoms were left hemiplegia (n = 1), left hemiparesis (n = 3) and seizure (n = 2). Preoperative consciousness level was Japan Coma Scale 2 (n = 6), 20 (n = 2), or 200 (n = 1). The procedure consisted of hemiarch replacement (n = 4) or total arch replacement (n = 5). Aorto-carotid bypass was performed in all patients under hypothermic circulatory arrest. The time from onset of symptoms to operating room was 7.2 ± 2.4 h. Hospital mortality was 0%. Left hemiplegia and left hemiparesis improved significantly. Japan Coma Scale was 0 in all patients at discharge. Overall survival at 24 months after operation was 100%. Aorto-carotid artery bypass for type A acute aortic dissection with carotid artery occlusion is the treatment of choice in these high-risk patients. Our strategy of ‘no touch until circulatory arrest’ may contribute to neurological improvement.

scholarly journals Sonographic features of carotid artery dissection due to extension of aortic dissection: a case report

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Christian Boßelmann ◽  
Sven Poli
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Point Of Care ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Carotid Ultrasound ◽  
Case Presentation ◽  
Retrosternal Pain ◽  
Hemodynamic Assessment

Abstract Background Carotid artery dissection due to extension of aortic dissection (CAEAD) is a severe complication of acute aortic dissection. The risk of ischemic stroke is increased. Early sonographic detection and repeat evaluation are necessary to guide clinical management. Case presentation A 58-year-old male patient presents with sudden, tearing retrosternal pain. Point-of-care carotid ultrasound is used to establish the diagnosis of CAEAD. We describe a number of sonographic features and compare ultrasound to other imaging modalities. Conclusions Bedside carotid ultrasound enables rapid, sensitive and safe hemodynamic assessment, especially in critically ill patients.

scholarly journals Aggressive strategy to save the brain in a case of acute aortic dissection

2021 ◽  
Author(s):  
Kenji Minatoya
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Aortic Dissection ◽  
Cerebral Perfusion ◽  
Carotid Arteries ◽  
Acute Aortic Dissection ◽  
Extraanatomical Bypass ◽  
Cerebral Malperfusion ◽  
Common Carotid Arteries ◽  
The Brain

The case report by Sicim et al. is the placement of extra-anatomical bypasses in bilateral common carotid arteries. The similar previous reports of the extra-anatomical bypass usually indicate unilateral bypass. Whether or not the Willis’ circle is incomplete is difficult to judge during emergency surgery, and the authors’ judgment seems to have been correct in the sense that it could maintain cerebral perfusion reliably and quickly. The direct perfusion and extraanatomical bypass of carotid artery is a reasonable strategy in patients with cerebral malperfusion.

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