Besa Santiago, Castelli Fiorenza, Garrido-Olivares Luis, González Rodrigo, Marine Leopoldo, Becker Pedro
Division of Surgery, Department of Cardiovascular Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
Medical School, Pontificia Universidad Católica de Chile, Santiago, Chile.
Front Cardiovasc Med. 2023 Mar 6;10:1124181. doi: 10.3389/fcvm.2023.1124181. eCollection 2023.
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.
表现为脑灌注不良的急性A型主动脉夹层具有很高的发病率和死亡率。鉴于潜在血管受累的复杂性，这是一个具有挑战性的临床情况。这些患者中的许多人不被认为是手术候选人。如果考虑手术，通常需要复杂的主动脉弓和颈部血管重建。我们报告一名48岁男性，患有急性A型主动脉夹层，表现为截瘫和意识水平下降。计算机断层扫描显示双侧颈总动脉闭塞。他通过多部位灌注策略和杂交冷冻象鼻移植物成功治疗，以实现脑循环的快速恢复，并最大限度地减少脑缺血和永久性神经损伤。从这个病例中，我们了解到在多部位灌注支持下积极进行主动脉弓和颈部血管重建有助于改善部分患者的死亡率和神经功能结局。
