title: Endovascular management of symptomatic cerebral malperfusion due to carotid dissection after type A aortic dissection repair.
abstract: OBJECTIVE
  Type A acute aortic dissection is a surgical emergency, and supra-aortic trunk involvement may be complicated by stroke in 6% to 20% of cases. A 66-year-old Caucasian female patient underwent a composite repair of the ascending aorta for type A aortic dissection. Postoperative period was complicated by episodes of "drop attack." Doppler ultrasound of supra-aortic trunks revealed an intimal flap occluding right internal carotid artery.
  
  
  METHODS
  Multiple stenting was performed from carotid bifurcation to internal carotid artery in order to exclude the dissection intimal flap. After endovascular procedure physiatrist considered that motor functional improvement was better than expected, and we support that endovascular resolution of carotid malperfusion led to a better outcome.
  
  
  CONCLUSIONS
  According to other experience, endovascular procedure resulted as a safe and effective way. Moreover, ultrasound monitoring of supra-aortic trunks in postoperative period is recommended.
authors: Vascular Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy.
authors: R
authors: R
authors: Casana
authors: V
authors: V
authors: Tolva
authors: A Robecchi
authors: AR
authors: Majnardi
authors: P G
authors: PG
authors: Bianchi
authors: L
authors: L
authors: Addobati
authors: G B
authors: GB
authors: Bertoni
authors: L V
authors: LV
authors: Cireni
authors: V
authors: V
authors: Silani
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D020212:Carotid Artery Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D015641:Radiography, Interventional; D015607:Stents; D013575:Syncope / Q000209:etiology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler