Correction of symptomatic cerebral malperfusion due to acute type I aortic dissection by transcarotid stenting of the innominate and carotid arteries

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Correction of symptomatic cerebral malperfusion due to acute type I aortic dissection by transcarotid stenting of the innominate and carotid arteries Glen S. Roseborough, MD, Kieran P. Murphy, MD, Peter B. Barker, DPhil, Marc Sussman, MD Journal of Vascular Surgery Volume 44, Issue 5, Pages 1091-1096 (November 2006) DOI: 10.1016/j.jvs.2006.05.053 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 Diffusion-weighted magnetic resonance images of the brain performed 3 days after aortic reconstruction, before carotid stenting. Arrows point to multiple areas of restricted diffusion in the anterior and posterior watershed areas of the right cerebral hemisphere, consistent with acute infarcts. Journal of Vascular Surgery 2006 44, 1091-1096DOI: (10.1016/j.jvs.2006.05.053) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 A, Magnetic resonance imaging (MRI) perfusion-weighted images of the patient’s brain before revascularization with transcarotid stenting. Yellow regions represent hypoperfused areas of right hemisphere of the brain. B, Follow-up MRI 5 months after revascularization showing symmetrical perfusion of both hemispheres. Journal of Vascular Surgery 2006 44, 1091-1096DOI: (10.1016/j.jvs.2006.05.053) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 A, Magnetic resonance angiograph (MRA) of the aortic arch showing an intimal flap (IF) extending into the innominate artery and throughout the aortic arch. B, MRA showing an IF extending across the origins of the right subclavian and right carotid arteries. CCA, Common carotid artery; IA, innominate artery; IF, intimal flap; SCA, subclavian artery; VA, vertebral artery; R, right; L, left. Journal of Vascular Surgery 2006 44, 1091-1096DOI: (10.1016/j.jvs.2006.05.053) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Intraoperative retrograde angiogram performed after placement of the second stent into the proximal innominate artery. Contrast now refluxes throughout the innominate artery. Journal of Vascular Surgery 2006 44, 1091-1096DOI: (10.1016/j.jvs.2006.05.053) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 5 Intraoperative completion angiogram after transcarotid stenting, with good filling of both middle and anterior cerebral arteries. Journal of Vascular Surgery 2006 44, 1091-1096DOI: (10.1016/j.jvs.2006.05.053) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 6 Computed tomographic angiogram 2.5 years after treatment showing patent stents in the innominate and right common carotid arteries. Journal of Vascular Surgery 2006 44, 1091-1096DOI: (10.1016/j.jvs.2006.05.053) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions