Key result
Surgical correction of a kinked aortic graft halts recurrent embolic events in a single patient.
Why the study?
It addresses the clinical dilemma of whether a visible thrombus is required to justify redo surgery after type A dissection repair when recurrent embolism occurs under maximal medical therapy.
Does redo surgery to correct graft geometry prevent recurrent embolic events in a patient with a kinked ascending aortic graft and recurrent strokes despite optimal anticoagulation?
Case Report (n=1)
Does redo surgery to correct graft geometry prevent recurrent embolic events in a patient with a kinked ascending aortic graft and recurrent strokes despite optimal anticoagulation?
Surgical correction of a kinked ascending aortic graft may be indicated to prevent recurrent embolism even without visible thrombus when events persist despite optimal anticoagulation.
Kinked aortic grafts may cause recurrent cerebrovascular events despite anticoagulation; this case leaves open optimal post-repair surveillance and intervention.
BACKGROUND: We report a unique case of recurrent cerebrovascular events under adequate anticoagulation, in the absence of a visible thrombus, due to a severely kinked ascending aortic graft after type A dissection repair. CASE SUMMARY: A 70-year-old man developed 4 transient ischemic attacks and 3 ischemic strokes over 4 years despite therapeutic rivaroxaban levels and prior antiplatelet therapy. Imaging revealed a kinked ascending graft without thrombus. High-risk redo surgery was pursued to correct graft geometry, after which no further embolic events occurred during early follow-up (5 months). DISCUSSION: This case addresses the clinical dilemma whether a visible thrombus is required to justify redo surgery after type A repair, especially when recurrent embolism occurs under maximal medical therapy. TAKE-HOME MESSAGE: Surgical correction of graft kinking may be indicated-even in the absence of a thrombus-when embolic risk persists under optimal anticoagulation.
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Timmermans et al. (2026) conducted a case report in Recurrent cerebrovascular events after type A dissection repair (n=1). Redo surgery to correct graft geometry was evaluated on Recurrent embolic events. Surgical correction of a severely kinked ascending aortic graft prevented further embolic events over 5 months of follow-up in a patient with recurrent strokes despite optimal anticoagulation.
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