Direct perfusion of the carotid artery in patients with brain malperfusion secondary to acute aortic dissection

Okita, Yutaka; Ikeno, Yuki; Yokawa, Koki; Koda, Yojiro; Henmi, Soichiro; Gotake, Yasuko; Nakai, Hidekazu; Matsueda, Takashi; Inoue, Takeshi; Tanaka, Hiroshi

doi:10.1007/s11748-017-0873-y

Cited by 26 publications

(35 citation statements)

References 16 publications

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“…We reported our first successful case as a simple bypass circuit between the common FA and right CCA performed in the emergency room 30 . We found that lower reperfusion flow to the CCA was beneficial in terms of electroencephalographic recovery and brain water contents.…”

Section: Discussionmentioning

confidence: 90%

Treatment strategies for malperfusion syndrome secondary to acute aortic dissection

Okita

Okada

2020

J Card Surg

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Objective Presenting our experience of treating patients with organ malperfusion secondary to acute aortic dissection. Patients Among 383 patients who underwent aortic repair for acute type A aortic dissection from 1999 to 2017, 107 patients were operated on because of vascular complications. Fourteen patients had coronary, 50 had brain, 3 had paraplegia, 13 had superior mesenteric artery, 21 had lower limb, and 16 had combined organ malperfusion. Age was 65.8 years. Results In coronary malperfusion, three had a preoperative percutaneous coronary intervention, and two had mechanical support. All underwent repair of the aorta. Hospital mortality was 28.5%. Fifty patients had brain malperfusion. Hemiplegia was found in 28 patients, transient ischemic attack in 10, and coma in 12. The level of consciousness was severe in 12, moderate in 18, and mild in 20. Twenty‐eight percent died of a stroke. Nine had direct perfusion from the right common carotid artery, and the consciousness level was improved in 5 patients. Eight patients had mesenteric malperfusion. Four patients had a central aorta repair first, and four patients had peripheral intervention first. Three patients had a bypass grafting to the superior mesenteric artery, and one had a catheter intervention. Postoperative mortality was found in four patients due to bowel necrosis and six required resections of the bowel. Conclusion Acute organ malperfusion caused by the aortic dissection requires accurate and prompt diagnosis to proceed with an appropriate intervention before repairing the central aorta for preventing irreversible organ damage.

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Section: Discussionmentioning

confidence: 90%

Treatment strategies for malperfusion syndrome secondary to acute aortic dissection

Okita

Okada

2020

J Card Surg

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“…Extracorporeal femoral-carotid shunting for maintenance of antegrade cerebral perfusion has previously been reported, but with important differences. 1 , 2 , 3 , 4 These reports used either surgical bypass or surgical conduits connected to tubing and a centrifugal pump. Comparatively, our approach using endovascular sheaths eliminates the need for two surgical anastomoses and offers the potential for a percutaneous femoral approach, eliminating the need for groin exposure.…”

Section: Discussionmentioning

confidence: 99%

Novel use of the ENROUTE transcarotid arterial sheath for antegrade cerebral perfusion during retrograde innominate stenting

Barnes

Columbo

Kuwayama

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Femoral-carotid bypass has been described to preserve antegrade cerebral perfusion during aortic arch and great vessel interventions. We describe a novel use of the ENROUTE transcarotid arterial sheath (Silk Road Medical, Sunnyvale, Calif) as the outflow component of a femoral-carotid shunt for maintenance of antegrade cerebral perfusion during a retrograde innominate stenting procedure. We discuss the unique advantages of this sheath for use in this application.

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Section: Introductionmentioning

confidence: 99%

“…The pathophysiology of brain complications in acutely dissected patients is largely due to a compressed true lumen by the false lumen, static or dynamic [7]. It is often multifactorial, frequently coexisting with circulatory collapse, sequelae of acute hypoxia, and thromboembolism originating from the false lumen [7]. However, as a main cause of postoperative neurological deficiency, the possibility of thromboembolism owing to thrombi derived from a thrombosed false lumen has been noted [6,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Impact of direct carotid artery perfusion in acute type A aortic dissection involving the common carotid artery

Sugiyama

Watanuki

Futamura

et al. 2021

Gen Thorac Cardiovasc Surg

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Objectives Acute type A aortic dissection complicated with brain ischemia is associated with significantly higher mortality risks. Even if rescued with central aortic repair, some patients develop permanent postoperative neurological deficiency postoperatively. We recently introduced direct common carotid artery perfusion for acute type A aortic dissection involving the common carotid artery. This study introduced this technique to prevent postoperative neurological deficiency by comparing brain protection strategies. Methods Among 91 acute type A aortic dissection patients treated at our hospital during August 2015-October 2020, the common carotid artery was involved in 19 (21%), which had > 90% stenosis in either of the carotid arteries on preoperative contrast-enhanced computed tomography. Twelve patients underwent conventional selective cerebral perfusion during August 2015-December 2018 and seven patients underwent direct carotid artery perfusion during January 2019-October 2020. We assessed patient characteristics, surgical courses, clinical outcomes, and neurological outcomes. Results The mean age was 69 (range 39-84) years; 17 patients were male (89%). Eight patients (42%) had neurological symptoms. Concomitant procedures, postoperative neurological symptoms, and late mortality were significantly associated with conventional selective cerebral perfusion. Five selective cerebral perfusion patients experienced worsened neurological symptoms and two died of broad cerebral ischemia. No direct carotid artery perfusion patient died during hospitalization or experienced worsened neurological outcomes. Conclusions Direct carotid artery perfusion may be useful in aortic dissection with brain ischemia because it does not aggravate neurological symptoms and is not associated with intraoperative cerebral infarction. However, it may be ineffective when cerebral infarction has already developed.

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Direct perfusion of the carotid artery in patients with brain malperfusion secondary to acute aortic dissection

Abstract: Aggressive direct reperfusion of the carotid artery before the aortic repair may reduce neurological complications in patients with preoperative brain malperfusion secondary to acute aortic dissection.

Cited by 26 publications

References 16 publications

Treatment strategies for malperfusion syndrome secondary to acute aortic dissection

Treatment strategies for malperfusion syndrome secondary to acute aortic dissection

Novel use of the ENROUTE transcarotid arterial sheath for antegrade cerebral perfusion during retrograde innominate stenting

Impact of direct carotid artery perfusion in acute type A aortic dissection involving the common carotid artery

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