Thoracoscopic left atrial appendectomy and thoracic endovascular aortic repair (TEVAR) in a patient with cardiogenic stroke combined with acute aortic dissection

The simultaneous occurrence of cardiogenic stroke and acute aortic dissection is rare, and its treatment remains unclear. Although anticoagulation therapy is usually chosen for cardiogenic stroke due to atrial fibrillation, it is inappropriate for acute aortic dissection. Recently, thoracoscopic left atrial appendectomy (TLAA) has been suggested as an alternative for anticoagulation. We herein report a case of a 78-year-old man with combined cardiogenic stroke and acute aortic dissection in whom thoracic endovascular aortic repair (TEVAR) was performed after TLAA. Although anticoagulants were discontinued after TLAA, there was no recurrence of stroke, and he underwent TEVAR safely. This case indicates that TLAA followed by TEVAR is an ideal treatment for combined cardiogenic stroke and acute aortic dissection and also suggests a new indication of TLAA.