Rapid revascularization reverses cerebral and myocardial ischemia arising from aortic dissection.

Thrombolytic therapy is relatively contraindicated in aortic dissection (AD)–related cerebral and myocardial ischemia for high risk of bleeding. We report a 52-year-old woman experiencing acute cerebral and myocardial ischemia arising from AD. Intravenous recombinant tissue plasminogen activator treatment was held immediately when carotid duplex revealed common carotid artery dissection and chest computed tomography confirmed the existence of type A AD. Emergent surgery completely reversed her neurologic deficit and myocardial injury. We suggest that carotid duplex could be a useful tool to detect AD-related stroke before thrombolytic therapy and would not delay the timing for treatment.