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一例主动脉夹层手术修复过程中发生的颈动脉血栓导致的大规模术后中风。

A massive postoperative stroke caused by a carotid thrombus that occurred during the surgical repair of an aortic dissection.

作者信息

Nemoto Hiroko, Uchida Keiji, Minami Tomoyuki, Yasuda Shota, Cho Tomoki, Masuda Munetaka

机构信息

Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.

出版信息

SAGE Open Med Case Rep. 2021 Jun 12;9:2050313X211025215. doi: 10.1177/2050313X211025215. eCollection 2021.

DOI:10.1177/2050313X211025215
PMID:34178353
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8202300/
Abstract

A 59-year-old man with no prior neurological deficits developed a massive stroke during the repair of a double-barreled acute type A aortic dissection with major entry in the ascending aorta and an occluded brachiocephalic artery. As right cerebral ischemia was alleviated by the circle of Willis, the patient was alert and conscious preoperatively. Nevertheless, the thrombus in the right carotid artery induced a severe postoperative right cerebral embolism. In conclusion, occlusion of the carotid artery is a risk factor of postoperative severe stroke, even in patients without neurological symptoms preoperatively.

摘要

一名59岁既往无神经功能缺损的男性，在修复升主动脉有主要破口且头臂动脉闭塞的双腔急性A型主动脉夹层时发生大面积卒中。由于Willis环缓解了右侧脑缺血，患者术前神志清醒。然而，右侧颈动脉内的血栓导致了严重的术后右侧脑栓塞。总之，颈动脉闭塞是术后严重卒中的一个危险因素，即使是术前没有神经症状的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1f/8202300/73e36695fe25/10.1177_2050313X211025215-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1f/8202300/452d5b36e6d9/10.1177_2050313X211025215-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1f/8202300/73e36695fe25/10.1177_2050313X211025215-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1f/8202300/452d5b36e6d9/10.1177_2050313X211025215-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1f/8202300/73e36695fe25/10.1177_2050313X211025215-fig2.jpg

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本文引用的文献

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Gen Thorac Cardiovasc Surg. 2021 Nov;69(11):1467-1475. doi: 10.1007/s11748-021-01628-y. Epub 2021 Apr 2.
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Strategies to improve outcomes for acute type A aortic dissection with cerebral malperfusion.改善伴有脑灌注不良的急性 A 型主动脉夹层转归的策略。
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Differences of patients' characteristics in acute type A aortic dissection - surgical data from Belgian and Japanese centers.
急性A型主动脉夹层患者特征的差异——来自比利时和日本中心的手术数据
J Cardiothorac Surg. 2018 Sep 4;13(1):92. doi: 10.1186/s13019-018-0782-x.
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Malperfusion syndromes in type A aortic dissection: what we have learned from IRAD.A型主动脉夹层中的灌注不良综合征：我们从国际急性主动脉夹层注册研究（IRAD）中学到的内容。
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Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion.早期再灌注策略可改善合并灌注不良的急性 A 型主动脉夹层手术的结局。
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Direct perfusion of the carotid artery in patients with brain malperfusion secondary to acute aortic dissection.急性主动脉夹层继发脑灌注不良患者的颈动脉直接灌注。
Gen Thorac Cardiovasc Surg. 2019 Jan;67(1):161-167. doi: 10.1007/s11748-017-0873-y. Epub 2017 Dec 28.
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Long-term outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma.急性A型主动脉夹层合并昏迷患者立即进行主动脉修复后的长期预后。
J Thorac Cardiovasc Surg. 2014 Sep;148(3):1013-8; discussion 1018-9. doi: 10.1016/j.jtcvs.2014.06.053. Epub 2014 Jul 5.
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The Glasgow Coma Scale at 40 years: standing the test of time.格拉斯哥昏迷评分 40 年：经得起时间的考验。
Lancet Neurol. 2014 Aug;13(8):844-54. doi: 10.1016/S1474-4422(14)70120-6.
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J Am Coll Cardiol. 2011 Dec 6;58(24):2455-74. doi: 10.1016/j.jacc.2011.06.067.
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