Key result
Left subclavian artery to common carotid artery bypass followed by hybrid TEVAR was utilized to manage a 60-year-old female with complicated type B aortic dissection and compromised cerebral circulation.
Case Report (n=1)
This case demonstrates the successful management of compromised cerebral circulation during hybrid TEVAR for type B aortic dissection using a carotid-subclavian bypass.
Hybrid approach may be feasible in select complicated type B dissections with cerebral compromise; leaves open need for prospective validation.
Clinical Details A 60-year-old female presented with complicated type B aortic dissection (end organ ischemia), with location of entry tear just distal to origin of left subclavian artery ([ Fig. 1 A ]). She had a hypoplastic right vertebral artery ending as posterior inferior cerebellar artery, with dominant left vertebral artery solely constituting the vertebrobasilar circulation ([ Fig. 1 B ]). Hence, she was planned for emergency left subclavian artery to common carotid artery (CCA) bypass, followed by hybrid thoracic endovascular aortic repair (TEVAR). Fig. 1 ( A ) Complicated type B aortic dissection with location of entry tear just distal to origin of left subclavian artery. ( B ) CT showing hypoplastic right vertebral artery which terminates as posterior inferior cerebellar artery (PICA) and dominant left vertebral artery. ( C ) Pigtail aortogram following carotid-subclavian bypass showing patent carotid-subclavian bypass and nonvisualization of left vertebral artery. ( D ) Right subclavian angiogram confirming the right vertebral artery terminating as PICA, with no contribution to the vertebrobasilar system. ( E, F ) Right common carotid angiogram showing complete retrograde filling of basilar artery (arrow) through dominant posterior communicating artery (Pcom). Publication History Article published online: 12 September 2022 © 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd.
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Athiyappan et al. (2022) conducted a case report in Complicated type B aortic dissection (n=1). Left subclavian artery to common carotid artery bypass followed by hybrid TEVAR was evaluated. Left subclavian artery to common carotid artery bypass followed by hybrid TEVAR was utilized to manage a 60-year-old female with complicated type B aortic dissection and compromised cerebral circulation.
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