Rescue of Compromised Cerebral Circulation in Hybrid TEVAR for Type B Aortic Dissection

Clinical Details

A 60-year-old female presented with complicated type B aortic dissection (end organ ischemia), with location of entry tear just distal to origin of left subclavian artery ([Fig. 1A]). She had a hypoplastic right vertebral artery ending as posterior inferior cerebellar artery, with dominant left vertebral artery solely constituting the vertebrobasilar circulation ([Fig. 1B]). Hence, she was planned for emergency left subclavian artery to common carotid artery (CCA) bypass, followed by hybrid thoracic endovascular aortic repair (TEVAR).

Fig. 1 (A) Complicated type B aortic dissection with location of entry tear just distal to origin of left subclavian artery. (B) CT showing hypoplastic right vertebral artery which terminates as posterior inferior cerebellar artery (PICA) and dominant left vertebral artery. (C) Pigtail aortogram following carotid-subclavian bypass showing patent carotid-subclavian bypass and nonvisualization of left vertebral artery. (D) Right subclavian angiogram confirming the right vertebral artery terminating as PICA, with no contribution to the vertebrobasilar system. (E, F) Right common carotid angiogram showing complete retrograde filling of basilar artery (arrow) through dominant posterior communicating artery (Pcom).

Publikationsverlauf

Artikel online veröffentlicht:
12. September 2022

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