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Editorial
. 2022 Oct 30:17:18-22.
doi: 10.1016/j.xjtc.2022.10.012. eCollection 2023 Feb.

Uni- versus bilateral antegrade cerebral perfusion during repair of acute aortic dissection: Still a discussed matter!

Thierry Carrel  1 , Martin Schmiady  1 , Ahmed Ouda  1 , Paul Robert Vogt  1
Affiliations
Editorial

Uni- versus bilateral antegrade cerebral perfusion during repair of acute aortic dissection: Still a discussed matter!

Thierry Carrel et al. JTCVS Tech. .
No abstract available

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Figures

None
Unilateral (left) versus bilateral (right) antegrade cerebral perfusion.
Figure 1
Figure 1
Unilateral ACP during circulatory arrest through the arterial cannula of the cardiopulmonary bypass circuit. In this case, the innominate artery must be occluded (either by a clamp or by snare with tourniquet). In addition, occlusion of the left common carotid and subclavian arteries preclude backflow through the circle of Willisi and contribute to an increased intracerebral perfusion pressure.
Figure 2
Figure 2
A, Bilateral selective ACP with balloon catheters. Ideally, ACP is performed through a separate line connected to a smaller cardioplegia pump. B, Alternatively, ACP may be performed through the normal arterial return line using a Y-connector and clamping the right subclavian line (yellow arrow: subclavian artery line; white arrow: additional line for the bilateral cerebral perfusion; dotted arrows: perfusion catheters with balloon occlusion). C, Perfusion catheter with balloon occlusion through a separate line for selective ACP.
Figure 3
Figure 3
Postoperative computed tomography imaging and 3-dimensional reconstruction showing revascularization of the proximally occluded innominate artery with a vascular graft (arrows) between the ascending aorta (star) and the bifurcation of the innominate artery.
Figure 4
Figure 4
A, Angiographic imaging of the innominate artery shows retention of the contrast agent in the false lumen of the dissected common carotid artery (arrowheads). B, The dissected innominate artery and the right common carotid artery were treated with 2 kissing stents, which reached out into the aortic arch (star). The technique of the kissing stents ensures optimal distal perfusion of both the right subclavian and right carotid arteries and precludes compression or occlusion of one vessel through the other one. In addition, kissing stents allowed a safe closure of the supposed entry in the trunk, whereas vascular access in the true lumen was secured using ultrasound-guided puncture of the right carotid artery. C, Postinterventional computed angiography showing the 2 parallel stents in the innominate artery (arrows).
See this image and copyright information in PMC

References

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