Hybrid Technique to Correct Cerebral Malperfusion Following Repair of a Type A Aortic Dissection

Kim, Seon Hee; Song, Seunghwan; Kim, Sang-Pil; Lee, Jonggeun; Lee, Han Cheol; Kim, Eun Soo

doi:10.5090/kjtcs.2014.47.2.163

Cited by 5 publications

(6 citation statements)

References 5 publications

(6 reference statements)

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“…Patients had a median age of 64.5 years (IQR 57–70) for the case reports [ 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], and 60.5 years and 68 years in the cohorts [ 12 , 17 ]; 52% were female. A history of arterial hypertension (AH) was found in 83% of the cases.…”

Section: Resultsmentioning

confidence: 99%

Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review

Aita

Agripnidis

Testud

et al. 2022

JPM

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In this study, we report our local experience of type A aortic dissections in patients with cerebral malperfusion treated with carotid stenting before or after aortic surgery, and present a systematic literature review on these patients treated either with carotid stenting (CS) before or after aortic surgery (AS) or with aortic and carotid surgery alone (ACS). We report on patients treated in our center with carotid stenting for brain hemodynamic injury of carotid origin caused by type A dissection since 2018, and a systematic review was conducted in PubMed for articles published from 1990 to 2021. Out of 5307 articles, 19 articles could be included with a total of 80 patients analyzed: 9 from our center, 29 patients from case reports, and 51 patients from two retrospective cohorts. In total, 8 patients were treated by stenting first, 72 by surgery first, and 7 by stenting after surgery. The mean age; initial NIHSS score; time from symptom onset to treatment; post-treatment clinical improvement; post-treatment clinical worsening; mortality rate; follow-up duration; and follow-up mRS were, respectively, for each group (local cohort, CS before AS, ACS, CS after AS): 71.2 ± 5.3 yo, 65.5 ± 11.0 yo; 65.3 ± 13.1 yo, 68.7 ± 5.8 yo; 4 ± 8.4, 11.3 ± 8.5, 14.3 ± 8.0, 0; 11.8 ± 14.3 h, 21 ± 39.3 h, 13.6 ± 17.8 h, 13 ± 17.2 h; 56%, 71%, 86%, 57%; 11%, 28%, 0%, 14%; 25%, 12.3%, 14%, 33%; 5.25 ± 2.9 months, 54 months, 6.8 ± 3.8 months, 14 ± 14.4 months; 1 ± 1; 0.25 ± 0.5, 1.3 ± 0.8, 0.68 ± 0.6. Preoperative carotid stenting for hemodynamic cerebral malperfusion by true lumen compression appears to be feasible, and could be effective and safe, although there is still a lack of evidence due to the absence of comparative statistical analysis. The literature, albeit growing, is still limited, and prospective comparative studies are needed.

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Section: Resultsmentioning

confidence: 99%

Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review

Aita

Agripnidis

Testud

et al. 2022

JPM

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“…Another reason we performed open brachiocephalic artery stenting was low rSO2 value during SCP detected by INVOS. The cerebral monitoring devices are useful to assess adequate cerebral perfusion and help to decide the need for additional intervention [8]. Even though case 1 patient did not complain any neurological symptoms preoperatively, brachiocephalic artery intervention should be considered when the rSO2 was low without any known reasons.…”

Section: Discussionmentioning

confidence: 99%

Open brachiocephalic artery stent for static obstruction caused by acute type A aortic dissection

Kuwabara

Wakabayashi

Ise

et al. 2019

Journal of Surgical Case Reports

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Brachiocephalic artery dissection complicated by acute type A aortic dissection occasionally causes cerebral malperfusion. Although immediate central aortic repair has been the standard treatment for aortic dissection, dissection in supra-aortic vessels frequently remains after the surgery. The residual brachiocephalic artery dissection is reported to be associated with late neurological events. Therefore, additional intervention for brachiocephalic artery dissection during central aortic repair should be considered in selected cases. In this report, we describe two cases requiring open brachiocephalic artery stenting simultaneous with central aortic repair. There were no neurological or stent induced complications at latest follow-up.

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“…Intracranial carotid-ophthalmic aneurysms refer to aneurysms that originate from the distal dural ring (DDR) of the internal carotid artery (ICA) at the top of the cavernous sinus to the origin of the posterior communicating artery (PComA). They are known as C6 aneurysms or para-clinoid aneurysms, which account for approximately 5% of intracranial aneurysms[ 1 , 2 ]. The rates of fatality and disability are high because of the location of growth, complexity and specificity of ophthalmic segment aneurysms[ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…They are known as C6 aneurysms or para-clinoid aneurysms, which account for approximately 5% of intracranial aneurysms[ 1 , 2 ]. The rates of fatality and disability are high because of the location of growth, complexity and specificity of ophthalmic segment aneurysms[ 1 , 2 ]. Although endovascular and micro-neurosurgical technologies have been developing rapidly, ophthalmic segment aneurysms, especially large (diameter = 10-25 mm) and giant (diameter > 25 mm) aneurysms, are still considered a challenge for surgeons.…”

Section: Introductionmentioning

confidence: 99%

Application of hybrid operating rooms for clipping large or giant intracranial carotid-ophthalmic aneurysms

Nai

Yang

2020

WJCC

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BACKGROUND A hybrid operating room (Hybrid-OR) is a surgical theatre that combines a conventional operating room with advanced medical imaging devices. There are still plenty of limitations when endovascular treatment or microsurgical treatment is used individually to treat large or giant carotid-ophthalmic aneurysms. AIM To explore and summarize the technical features and effectiveness of the application of a Hybrid-OR in managing major intracranial carotid-ophthalmic aneurysms. METHODS The Department of Neurosurgery treated 12 cases of large or giant intracranial carotid-ophthalmic aneurysms between March 2013 and December 2019 in a Hybrid-OR. All cases were treated with clipping and parent vessel reconstruction. RESULTS With the assistance of the Hybrid-OR, the rate of incomplete intraoperative aneurysm clipping decreased from 25% (3/12) to 0%, while the rate of vessel stenosis decreased from 16.7% (2/12) to 8.35% (1/12). In terms of thromboembolic events, ischemic infarction complication occurred in only one patient, and none of the patients experienced embolic infarction complications. All 12 patients were followed for an average of 3 years, and no aneurysms recurred. The postoperative recovery was evaluated with the modified Rankin Scale (mRS): 11 patients showed no symptoms (mRS = 0), 1 patient showed slight disability (mRS 1-2), and none of the patients had severe disability (mRS = 5) or died (mRS = 6). CONCLUSION The Hybrid-OR provides new ideas for the surgical clipping of large or giant intracranial carotid-ophthalmic aneurysms and decreases the rate of intraoperative vessel stenosis and unsuccessful clipping.

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Hybrid Technique to Correct Cerebral Malperfusion Following Repair of a Type A Aortic Dissection

Cited by 5 publications

References 5 publications

Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review

Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review

Open brachiocephalic artery stent for static obstruction caused by acute type A aortic dissection

Application of hybrid operating rooms for clipping large or giant intracranial carotid-ophthalmic aneurysms

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