Early aortic repair and decompressive hemicraniectomy in aortic dissection with ischaemic stroke

Author:

Mohamed Walid1ORCID,Zaheer Aneel2,Deshpande Ranjit2

Affiliation:

1. Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK

2. Department of Cardiac Surgery, King’s College Hospital, London, UK

Abstract

The presence of stroke in patients with type A acute aortic dissection confers worse clinical outcomes and represents a therapeutic dilemma. While emergency surgical repair is the ideal management strategy, the risk of further cerebral insult is a cause of concern, especially in the elderly moribund patient, where delayed repair or a conservative approach may be considered. A 67-year-old female presented with chest pain and left-sided hemiparesis and was diagnosed with extensive type A acute aortic dissection and ischaemic stroke secondary to right common carotid artery stenosis. She underwent two major operations (emergency dissection repair and hemicraniectomy) and sustained several complications. Despite her eventful postoperative recovery, she was discharged after 6 weeks to a neurorehabilitation unit with a mild neurological deficit. Due to subsequent pulmonary complications, the patient died 5 weeks later. The present report appraises the current evidence on the management of patients with type A acute aortic dissection presenting with neurological sequelae.

Publisher

SAGE Publications

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Safety Research,Radiology, Nuclear Medicine and imaging,General Medicine

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