1984
DOI: 10.1055/s-2007-1023429 View full text |Buy / Rent full text
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Abstract: This report describes a case of acute type A aortic dissection which had resulted in coma. Angiography had revealed obstruction of the right common carotid artery. Since signs of impending aortic rupture or severe aortic insufficiency were missing, an extraanatomic femoro-carotid bypass was inserted and resulted in the patient's regaining consciousness. Two days after the first operation, the ascending aorta and aortic valve were reconstructed successfully anastomosing the divided caudad end of the bypass to t… Show more

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“…Surgical revascularization of the carotid artery has been performed successfully with an extra-anatomic bypass to reverse an ischemic neurologic deficit 2 days before aortic reconstruction of a proximal dissection, as reported by Walterbusch et al 45 Despite this report, the convention in the cardiac surgery community is to defer carotid revascularization before aortic reconstruction, because repair of the dissected membrane may correct the problem. Furthermore, there is concern that a hemorrhagic infarct may result from the anticoagulation used during aortic reconstruction.…”
Section: Discussionmentioning
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“…Surgical revascularization of the carotid artery has been performed successfully with an extra-anatomic bypass to reverse an ischemic neurologic deficit 2 days before aortic reconstruction of a proximal dissection, as reported by Walterbusch et al 45 Despite this report, the convention in the cardiac surgery community is to defer carotid revascularization before aortic reconstruction, because repair of the dissected membrane may correct the problem. Furthermore, there is concern that a hemorrhagic infarct may result from the anticoagulation used during aortic reconstruction.…”
Section: Discussionmentioning
“…Walterbusch et al 4 reported in 1984 a case of restoration of carotid blood flow by femorocarotid bypass in acute aortic dissection before ascending aorta reconstruction. In 2008, Schonholtz et al 5 described a percutaneous external shunt to restore carotid flow in a patient with acute type A aortic dissection and carotid occlusion.…”
Section: Discussionmentioning
“…Because the combination of heparinization and resto ration of the cerebral blood flow results from operative intervention and may cause cerebral hemorrhage and worsening of the infarction, it has been recommended that these patients should be treated medically until their neurological condition stabilizes [8], New possibility offered by improvement of biocompatibility of blood exposed surfaces in cardiopulmonary bypass will allow operation on these patients without systemic heparinization [II], Nonetheless, other groups have advocated consideration of surgical intervention even in the presence of an acute stroke, given the grave prognosis of the underlying aortic pathology [ 12,13], At Stanford University, the approach to management of patients with aortic dissection has been straightforward. Surgical repair of the most diseased portion of the tho racic aorta to eliminate the most likely cause of death is considered paramount [4], In patients with acute type A dissection complicated by stroke, the treatment has still been directed primarily at the most immediate, lifethreatening event which is the acutely dissected aorta.…”
Section: Discussionmentioning