Aortic arch replacement for recurrent cerebral embolization

Gilead Lancaster, Constantinos J. Lovoulos, Michael Moussouttas, Andrew H. Goldstein, Dana Leifer, Pierre B. Fayad, Drew Olsen, John A. Elefteriades

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Replacement of the aortic arch for atheroma with cerebral embolization is in its infancy. The appropriateness of such intervention is controversial. Over a 10-month period, a 58-year-old woman suffered multiple debilitating cerebral vascular accidents manifested by motor, sensory, and memory deficits and documented by computed tomographic scanning and magnetic resonance imaging. Carotid and vertebral arteries were free of arteriosclerotic disease. Transesophageal echocardiography demonstrated two large atheromas with friable, pedunculated forms, one in the aortic arch and one in the very proximal descending thoracic aorta. Transcranial ultrasound revealed recurrent cerebral microembolic events. Cerebrovascular events continued, and the atheromas increased in size, despite treatment with Coumadin and aspirin. Under deep hypothermic arrest, the segment of the aortic arch harboring the atheroma was excised and replaced with a Dacron graft. Repeat transcranial ultrasound revealed cessation of embolic signals. All cerebrovascular events ceased. No further anticoagulation therapy was required. The patient has made substantial recovery from the preoperative deficits and continues to do well 1 year after aortic arch replacement. Resection of mobile aortic arch atheromas is likely to become increasingly important in the future as transesophageal echocardiography leads to their more common identification as a cause of cerebral ischemic events.

Original languageEnglish (US)
Pages (from-to)291-294
Number of pages4
JournalAnnals of Thoracic Surgery
Volume73
Issue number1
DOIs
StatePublished - Jan 31 2002

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Thoracic Aorta
Atherosclerotic Plaques
Transesophageal Echocardiography
Polyethylene Terephthalates
Vertebral Artery
Memory Disorders
Warfarin
Carotid Arteries
Aspirin
Accidents
Blood Vessels
Magnetic Resonance Imaging
Transplants
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Lancaster, G., Lovoulos, C. J., Moussouttas, M., Goldstein, A. H., Leifer, D., Fayad, P. B., ... Elefteriades, J. A. (2002). Aortic arch replacement for recurrent cerebral embolization. Annals of Thoracic Surgery, 73(1), 291-294. https://doi.org/10.1016/S0003-4975(01)03010-7

Aortic arch replacement for recurrent cerebral embolization. / Lancaster, Gilead; Lovoulos, Constantinos J.; Moussouttas, Michael; Goldstein, Andrew H.; Leifer, Dana; Fayad, Pierre B.; Olsen, Drew; Elefteriades, John A.

In: Annals of Thoracic Surgery, Vol. 73, No. 1, 31.01.2002, p. 291-294.

Research output: Contribution to journalArticle

Lancaster, G, Lovoulos, CJ, Moussouttas, M, Goldstein, AH, Leifer, D, Fayad, PB, Olsen, D & Elefteriades, JA 2002, 'Aortic arch replacement for recurrent cerebral embolization', Annals of Thoracic Surgery, vol. 73, no. 1, pp. 291-294. https://doi.org/10.1016/S0003-4975(01)03010-7
Lancaster G, Lovoulos CJ, Moussouttas M, Goldstein AH, Leifer D, Fayad PB et al. Aortic arch replacement for recurrent cerebral embolization. Annals of Thoracic Surgery. 2002 Jan 31;73(1):291-294. https://doi.org/10.1016/S0003-4975(01)03010-7
Lancaster, Gilead ; Lovoulos, Constantinos J. ; Moussouttas, Michael ; Goldstein, Andrew H. ; Leifer, Dana ; Fayad, Pierre B. ; Olsen, Drew ; Elefteriades, John A. / Aortic arch replacement for recurrent cerebral embolization. In: Annals of Thoracic Surgery. 2002 ; Vol. 73, No. 1. pp. 291-294.
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