Management of Acute Type A Aortic Dissection after Thrombolytic Therapy for Cerebral Infarction

• Published in: Japanese Journal of Vascular Surgery Vol. 30; no. 5; pp. 273 - 277
• Main Authors: Saitoh, Masato, Yamasaki, Takuma, Tanabe, Tomoaki, Tochigi, Shuichi, Tatebe, Shoh, Tei, Imun
• Format: Journal Article
• Language: Japanese
• Published: JAPANESE SOCIETY FOR VASCULAR SURGERY 03-09-2021
• Subjects: acute aortic dissection; cerebral infarction; recombinant tissue Plasminogen Activator
• ISSN: 0918-6778; 1881-767X
• DOI: 10.11401/jsvs.21-00051

A 57-year-old man with cerebral infarction who was treated at another hospital with 24 million IU of recombinant tissue Plasminogen Activator was referred to our hospital after he was found to have acute type A aortic dissection. His primary complaint at presentation was partial paralysis of the left upper limb. Contrast-enhanced computed tomography scan revealed dissection of the three branches of the neck, a narrowed true lumen in the right common carotid artery, and an opening in the aortic root. Echocardiography revealed severe aortic regurgitation. We urgently performed total arch aortic replacement with the frozen elephant trunk technique and aortic valvuloplasty. We administered high doses of tranexamic acid in the perioperative period and applied intraoperative maneuvers. The patient was discharged without complications. Our results suggest that perioperative preventive measures against hemorrhage, such as reconstruction of the dissected neck branch as early as possible and resumption of blood flow even when recombinant tissue Plasminogen Activator has been administered, can lead to neurological improvement and ultimately save the patient’s life.