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CASE REPORT article

Front. Cardiovasc. Med.
Sec. Aortic Surgery and Endovascular Repair Archive
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1429287
This article is part of the Research Topic New Advances in Branches Reconstruction During Endovascular Repair of Aortic Pathologies View all 8 articles

"Surmounting the Summit: Tackling Cerebral Malperfusion in AMDS-Treated Acute DeBakey I Dissections. A case report"

Provisionally accepted
Nunzio D. De Manna Nunzio D. De Manna 1*Florian Helms Florian Helms 1Ezin Deniz Ezin Deniz 1Till Kaireit Till Kaireit 2Omar Abu-Fares Omar Abu-Fares 2Bastian Schmack Bastian Schmack 1Arjang Ruhparwar Arjang Ruhparwar 1Alexander Weymann Alexander Weymann 1Aron F. Popov Aron F. Popov 1
  • 1 Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
  • 2 Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany

The final, formatted version of the article will be published soon.

    Background: Acute Type A aortic dissection (ATAAD) with supra-aortic branch (SAB) malperfusion remains a formidable clinical challenge, often resulting in high mortality and complex treatment dilemmas. The introduction of the AMDS represents a significant innovation, designed to stabilize the aortic arch, and manage malperfusion effectively.Methods: This case study evaluates the utility of AMDS in the treatment of a 63-year-old male with hypertension, who presented with severe, acute chest pain. Diagnosed with a DeBakey type I ATAAD involving SAB, the patient underwent cardiopulmonary bypass, aortic root replacement, aortic arch repair with AMDS implantation, and subsequent endovascular stenting for severe left common carotid artery malperfusion that developed postoperatively. The AMDS was instrumental in facilitating crucial aortic arch reconstruction and addressing the initial severe malperfusion. Despite postoperative cerebral malperfusion, targeted endovascular stenting resulted in a rapid and substantial neurological recovery. The patient was discharged to a rehabilitation facility on postoperative day 20, free of neurological deficits.The use of AMDS in managing ATAAD with SAB involvement is transformative, enabling less invasive surgical techniques and offering immediate, effective correction of malperfusion. This case underscores the essential role of integrating advanced endovascular strategies to enhance outcomes in high-risk aortic surgeries, marking a pivotal advancement in the therapeutic approach to complex aortic dissections.

    Keywords: Acute aortic dissection, Ascyrus Medical Dissection Stent, Cerebral Malperfusion, Stroke endovascular treatment ATAAD, Acute type A aortic dissection, SAB, supra-aortic branch, AMDS, Ascyrus Medical Dissection Stent, LCCA, left common carotid artery, CT, computed tomography, CPB, cardiopulmonary bypass, HCA, hypothermic circulatory arrest, TL, true lumen

    Received: 07 May 2024; Accepted: 30 Aug 2024.

    Copyright: © 2024 De Manna, Helms, Deniz, Kaireit, Abu-Fares, Schmack, Ruhparwar, Weymann and Popov. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Nunzio D. De Manna, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany

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