Introduction
Acute type A aortic dissection (ATAAD) is a life-threatening disease that can present with severe neurological deficits such as a hemi symptomatic aor a comatose state caused by cerebral malperfusion (CM). CM due to concomitant dissection of the supra-aortic vessels with carotid artery occlusion is of especially poor prognosis, with up to 40% in-hospital mortality (1).
Established consensus in the treatment of ATAAD patients is immediate surgery in order to replace the damaged aortic segments, obliterate blood flow in the false lumen and restore blood supply of the brain and visceral organs. Nonetheless, surgical repair for ATAAD in presence of internal carotid artery (ICA) obstruction may often be futile, as patients are of high risk of developing cerebral edema and herniation syndrome, and has recently been shown of fatal prognosis(1).
Here, were present a case of an ATAAD patient with left-sided ICA occlusion, in whom percutaneous carotid recanalization and stenting was performed prior to open aortic surgery in order to restore cerebral perfusion in an interdisciplinary, staged treatment approach.