Extended Cerebral Infarction Due to Preoperative Free-Floating Thrombus in Right Internal Carotid Artery Complicated with Acute Type-A Aortic Dissection
Satoshi Yamashiro*, Ryoko Arakaki, Yuya Kise, Hitoshi Inafuku and Yukio Kuniyoshi
Department of Thoracic and Cardiovascular Surgery, Ryukyu University Hospital, Okinawa, Japan
- *Corresponding Author:
- Satoshi Yamashiro MD, PhD
Department of Thoracic and
Ryukyu University Hospital
207 Uehara, Nishihara
Nakagami, Okinawa 903-0215, Japan
Tel: (+81)-98-895-1168 Fax: (+81)-98-895-1422
E-mail: [email protected]
Received Date: December 19, 2013; Accepted Date: January 23, 2014; Published Date: January 25, 2014
Citation: Yamashiro S, Arakaki R, Kise Y, Inafuku H, Kuniyoshi Y (2014) Extended Cerebral Infarction Due to Preoperative Free-Floating Thrombus in Right Internal Carotid Artery Complicated with Acute Type-A Aortic Dissection. J Vasc Med Surg 2:126. doi: 10.4172/2329-6925.1000126
Copyright: © 2014 Yamashiro S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
A 59-year-old man, who has cutaneous polyarteritis nodosa, presented with sudden onset of excruciating neck pain and syncope. Chest CT disclosed a Stanford type a acute aortic dissection. He rapidly lost consciousness and cardiac tamponade caused a drop in blood pressure. Emergency ascending aortic replacement proceeded under deep hypothermic circulatory arrest with antegrade selective cerebral perfusion and the cerebral blood supply was monitored throughout the procedure. However, post-operative brain CT imaging revealed extensive right hemispheric brain infarction. A large thrombus was identified in the right internal carotid artery. Whether the mechanism of brain ischemia associated with the aortic dissection was hemodynamic ischemia or thromboembolism remained unclear. We considered that thrombectomy might be needed before selective cerebral perfusion.