頸動脈ステント留置後に上行大動脈置換術を実施して救命した左総頸動脈急性閉塞合併Stanford A 型急性大動脈解離の1 例

A 63-year old woman was admitted to our hospital due to loss of consciousness ［Glasgow Coma Scale （GCS） E1V1M4］. Cerebral angiography showed known severe stenosis in the right common carotid artery and acute occlusion of the left common carotid artery. Enhanced computed tomography（CT） revealed Stanford type A acute aortic dissection. We judged an emergency surgery was not indicated for this comatose patient. Neurosurgeons placed stents into the left common and internal carotid arteries. The next day, the patient regained consciousness （GCS E4V2M6）， and we performed ascending aorta replacement. There was an intimal tear in the ascending aorta and proximal end of the left carotid artery stent was visible in the aortic arch. Postoperative course was uneventful, and CT revealed successful aortic repair and patent stents in the left carotid artery. She was transferred to a rehabilitation hospital on postoperative day 44. Although stent insertion into carotid arteries in a patient with acute aortic dissection carries some risks such as making a new intimal tear or catheterizing in a false lumen, early cerebral reperfusion may improve prognosis of the patients with acute aortic dissection with cerebral malperfusion.