Innominate artery dissection during cerebral perfusion. The exception
that proves the rule.
Bilateral antegrade selective cerebral perfusion has the undisputed
advantage of being more physiological and theoretically ensuring
complete perfusion of the whole brain. However, it requires longer
execution times and manipulation of the epiaortic vessels. On the other
hand, unilateral selective cerebral perfusion (u-ASCP) avoids the
vessels manipulation, placement of catheters into the ostia of the great
vessels which clutters the operative field and incurs both
atherosclerotic and air embolism risk. Neverthless, an ongoing debate
about which technique yields the best clinical outcomes is still open.