External carotid-to-subclavian artery bypass in stent grafting of thoracic aorta

Left Subclavian-Bilateral External Carotid Artery Bypass for Symptomatic Carotid Artery Dissection Secondary to Open Repair of Type A Aortic Dissection

Symptomatic carotid dissection, secondary to surgical repair of Stanford type A acute aortic dissection (AAD), requires prompt intervention. A 56-year-old man who underwent total arch replacement with frozen elephant trunk for AAD presented with left hemiplegia and unilateral spatial neglect 16 h after the surgery. Cerebral computed tomography (CT) revealed no fresh lesions, and CT angiography showed severe bilateral carotid dissection. The patient’s neurological symptoms improved soon after left subclavian-bilateral external carotid artery bypass to correct symptomatic severe right cerebral ischemia. Therefore, this technique can be a good option for symptomatic carotid dissection in selected patients.