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Ann Thorac Surg 2004;77:1448-1449
© 2004 The Society of Thoracic Surgeons

Case report

Lethal thrombus in the carotid artery during operation for acute aortic dissection with cerebral malperfusion

Kazuhito Imanaka, MDa*, Motonobu Nishimura, MDa, Ayumu Masuoka, MDa, Masanori Ogiwara, MDa, Masaaki Kato, MDa, Haruhiko Asano, MDa, Shunei Kyo, MDa

a Department of Cardiovascular Surgery, Saitama Medical School, Saitama, Japan

Accepted for publication April 28, 2003.

* Address reprint requests to Dr Imanaka, Department of Cardiovascular Surgery, Saitama Medical School, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
e-mail: imanaka{at}saitama-med.ac.jp

A drowsy patient with acute type A aortic dissection and cerebral malperfusion required emergency operation. Because the right carotid artery was totally obstructed, cerebral perfusion was first restored by cannulating it and the left femoral artery before midline sternotomy. However, a long fresh thrombus was found flowing backward from the obstructed carotid artery. This thrombus was removed, and both arteries were connected through a Y-shaped extracorporeal circulation circuit to reperfuse the brain. During the subsequent aortic procedure, both arteries were used for arterial inflow. Such thrombi can cause grave postoperative neurologic dysfunction. Carotid artery cannulation is mandatory in such cases.




This article has been cited by other articles:


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 J. Thorac. Cardiovasc. Surg.Home page
M. Ando, K. Imanaka, H. Yamabi, and H. Sato
Successful emergency surgery for coexistent acute aortic syndrome and acute carotid artery obstruction
J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 771 - 773.
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