Key result
Salvage aortic replacement plus IVUS-guided LMCA stenting rescues a comatose patient with type A dissection.
Why the study?
The report highlights the management of acute type A aortic dissection in patients presenting with severe neurological impairment.
Case Report (n=1)
No
This case demonstrates that aggressive multidisciplinary management, including salvage aortic surgery and subsequent PCI for residual coronary dissection, can yield full cardiac and neurological recovery in comatose patients with acute type A aortic dissection.
May inform management of rare coronary complications in type A dissection; leaves open whether aggressive strategies warrant broader adoption.
A 74-year-old female was found hemiplegic in a public restroom. After arrival in our stroke unit, a computed tomography (CT) was performed, and she was diagnosed with bilateral carotid artery and right vertebral artery occlusion due to an acute type A aortic dissection. The patient deteriorated quickly to a GCS of 3 and was brought to the operating room, where a salvage replacement of the ascending aorta and the proximal aortic arch was performed with unilateral antegrade cerebral perfusion. Three days later, a significant decrease in left ventricular function and increase in cardiac biomarkers were observed. Coronary CT displayed residual dissection of the aortic root, extending into the left main coronary artery. The patient underwent an intravascular ultrasound-guided stenting of the left main, resulting in total recovery of heart function. She was extubated on the fourth postoperative day, with no residual neurological impairment. This case report advocates for the proper management of patients with ATAAD with severe neurological impairment, emphasizing the importance of a robust multidisciplinary approach in their care.
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Bidovec et al. (2025) conducted a case report in Acute type A aortic dissection with cerebral malperfusion (n=1). Salvage aortic replacement and IVUS-guided left main coronary stenting was evaluated on Clinical recovery. Salvage aortic replacement followed by IVUS-guided stenting of the left main coronary artery resulted in full cardiac and neurological recovery in a comatose patient with acute type A aortic dissection.
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