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Case report: Multi-site perfusion strategy for type A acute aortic dissection complicated with cerebral malperfusion

Acute type A dissection presenting with cerebral malperfusion has high morbidity and mortality. Given the complexity of underlying vascular involvement, it is a challenging clinical scenario. Many of these patients are not deemed surgical candidates. If surgery is considered, it often requires compl...

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Autores principales: Besa, Santiago, Castelli, Fiorenza, Garrido-Olivares, Luis, González, Rodrigo, Marine, Leopoldo, Becker, Pedro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10025532/
https://www.ncbi.nlm.nih.gov/pubmed/36950285
http://dx.doi.org/10.3389/fcvm.2023.1124181
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author Besa, Santiago
Castelli, Fiorenza
Garrido-Olivares, Luis
González, Rodrigo
Marine, Leopoldo
Becker, Pedro
author_facet Besa, Santiago
Castelli, Fiorenza
Garrido-Olivares, Luis
González, Rodrigo
Marine, Leopoldo
Becker, Pedro
author_sort Besa, Santiago
collection PubMed
description Acute type A dissection presenting with cerebral malperfusion has high morbidity and mortality. Given the complexity of underlying vascular involvement, it is a challenging clinical scenario. Many of these patients are not deemed surgical candidates. If surgery is considered, it often requires complex aortic arch and neck vessel reconstruction. We present a 48-year-old male with an acute type A aortic dissection that presented with paraplegia and decreased level of consciousness. A Computed Tomography showed occlusion of both common carotid arteries. He was successfully treated with a multi-site perfusion strategy and a Hybrid Frozen Elephant Trunk graft to achieve fast restoration of the cerebral circulation and minimize brain ischemia and permanent neurological damage. From this case, we learn that aggressive arch and neck vessel reconstruction supported by multi-site perfusion could help improve mortality and neurological outcomes in selected patients.
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spelling pubmed-100255322023-03-21 Case report: Multi-site perfusion strategy for type A acute aortic dissection complicated with cerebral malperfusion Besa, Santiago Castelli, Fiorenza Garrido-Olivares, Luis González, Rodrigo Marine, Leopoldo Becker, Pedro Front Cardiovasc Med Cardiovascular Medicine Acute type A dissection presenting with cerebral malperfusion has high morbidity and mortality. Given the complexity of underlying vascular involvement, it is a challenging clinical scenario. Many of these patients are not deemed surgical candidates. If surgery is considered, it often requires complex aortic arch and neck vessel reconstruction. We present a 48-year-old male with an acute type A aortic dissection that presented with paraplegia and decreased level of consciousness. A Computed Tomography showed occlusion of both common carotid arteries. He was successfully treated with a multi-site perfusion strategy and a Hybrid Frozen Elephant Trunk graft to achieve fast restoration of the cerebral circulation and minimize brain ischemia and permanent neurological damage. From this case, we learn that aggressive arch and neck vessel reconstruction supported by multi-site perfusion could help improve mortality and neurological outcomes in selected patients. Frontiers Media S.A. 2023-03-06 /pmc/articles/PMC10025532/ /pubmed/36950285 http://dx.doi.org/10.3389/fcvm.2023.1124181 Text en Copyright © 2023 Besa, Castelli, Garrido-Olivares, González, Marine and Becker. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Besa, Santiago
Castelli, Fiorenza
Garrido-Olivares, Luis
González, Rodrigo
Marine, Leopoldo
Becker, Pedro
Case report: Multi-site perfusion strategy for type A acute aortic dissection complicated with cerebral malperfusion
title Case report: Multi-site perfusion strategy for type A acute aortic dissection complicated with cerebral malperfusion
title_full Case report: Multi-site perfusion strategy for type A acute aortic dissection complicated with cerebral malperfusion
title_fullStr Case report: Multi-site perfusion strategy for type A acute aortic dissection complicated with cerebral malperfusion
title_full_unstemmed Case report: Multi-site perfusion strategy for type A acute aortic dissection complicated with cerebral malperfusion
title_short Case report: Multi-site perfusion strategy for type A acute aortic dissection complicated with cerebral malperfusion
title_sort case report: multi-site perfusion strategy for type a acute aortic dissection complicated with cerebral malperfusion
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10025532/
https://www.ncbi.nlm.nih.gov/pubmed/36950285
http://dx.doi.org/10.3389/fcvm.2023.1124181
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