Lethal thrombus in the carotid artery during operation for acute aortic dissection with cerebral malperfusion.
A drowsy patient with acute type A aortic dissection and cerebral malperfusion required emergency operation. Because the right carotid artery was totally obstructed, cerebral perfusion was first restored by cannulating it and the left femoral artery before midline sternotomy. However, a long fresh thrombus was found flowing backward from the obstructed carotid artery. This thrombus was removed, and both arteries were connected through a Y-shaped extracorporeal circulation circuit to reperfuse the brain. During the subsequent aortic procedure, both arteries were used for arterial inflow. Such thrombi can cause grave postoperative neurologic dysfunction. Carotid artery cannulation is mandatory in such cases.
Imanaka
Kazuhito
K
Department of Cardiovascular Surgery, Saitama Medical School, Iruma-gun, Japan. imanaka@saitama-med.ac.jp
Nishimura
Motonobu
M
Masuoka
Ayumu
A
Ogiwara
Masanori
M
Kato
Masaaki
M
Asano
Haruhiko
H
Kyo
Shunei
S
D000208:Acute Disease; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D002341:Carotid Artery Thrombosis / Q000209:etiology / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology*; D004630:Emergencies; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery; D008297:Male; D008875:Middle Aged