title: Correction of symptomatic cerebral malperfusion due to acute type I aortic dissection by transcarotid stenting of the innominate and carotid arteries.
abstract: BACKGROUND
  Acute proximal aortic dissection may be complicated by stroke due to malperfusion of the arch vessels. We report a novel case of successful endovascular treatment of acute cerebral malperfusion due to a dissection involving the aortic arch.
  
  
  METHODS
  A 66 year old man was transferred from another hospital with an acute type I aortic dissection and underwent emergent repair of the aortic valve and ascending aorta with a composite graft. Left hemiplegia and altered cognitive function were noted on postoperative day 1. A carotid duplex scan showed partial thrombosis of the right carotid artery with very slow flow and reversal of flow in the right vertebral artery. A head CT was normal, while a head MRI and MR angiogram showed intraluminal defects in the inominate and right carotid arteries and perfusion abnormality of the entire right middle cerebral artery territory, but only small infarcts of watershed areas. The patient underwent stenting of the right carotid and inominate arteries through the right carotid artery with complete resolution of a large pressure gradient that was noted prior to stenting. The patient's left hemiplegia and cognitive impairment subsequently resolved during his inpatient hospitalization. On follow up five months later, he had a normal neurologic exam and MRI showed old watershed infarcts but no perfusion abnormality. On most recent follow-up 2.5 years after treatment, he remains well and a CT angiogram shows that his stented vessels remain patent.
  
  
  CONCLUSIONS
  Endovascular techniques may be safely applied to correct cerebral malperfusion that results from type I aortic dissection.
authors.affiliation: Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD 21287, USA. gsrosebo@jhmi.edu
authors.forename: Glen S
authors.initials: GS
authors.lastname: Roseborough
authors.forename: Kieran P
authors.initials: KP
authors.lastname: Murphy
authors.forename: Peter B
authors.initials: PB
authors.lastname: Barker
authors.forename: Marc
authors.initials: M
authors.lastname: Sussman
mesh_terms: D000208:Acute Disease; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000175:diagnosis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016122:Brachiocephalic Trunk / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery*; D002560:Cerebrovascular Circulation; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler