Department of Cardiovascular Surgery, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan.
Division of Internal Medicine, Tokyo-Shinagawa Hospital, Shinagawa, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2020 Aug 1;31(2):263-265. doi: 10.1093/icvts/ivaa092.
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.
手术治疗伴有颈动脉闭塞的急性 A 型主动脉夹层仍存在争议。2012 年 12 月至 2017 年 6 月，我院共对 127 例急性 A 型主动脉夹层患者进行了手术治疗。其中 9 例（7.08%）患者因颈动脉闭塞导致脑灌注不良。闭塞部位为无名动脉（n=5）或右侧颈动脉（n=4）。术前神经症状为左侧偏瘫（n=1）、左侧轻偏瘫（n=3）和癫痫发作（n=2）。术前意识水平为日本昏迷量表 2 分（n=6）、20 分（n=2）或 200 分（n=1）。手术方式包括半弓置换（n=4）或全弓置换（n=5）。所有患者在低温循环中断下进行主动脉-颈动脉旁路术。从症状发作到进入手术室的时间为 7.2±2.4 h。住院死亡率为 0%。左侧偏瘫和左侧轻偏瘫明显改善。出院时所有患者日本昏迷量表评分为 0 分。术后 24 个月的总生存率为 100%。对于伴有颈动脉闭塞的急性 A 型主动脉夹层，主动脉-颈动脉旁路术是这些高危患者的治疗选择。我们的“不接触直至循环停止”策略可能有助于神经功能的改善。
