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A Journal on Surgery

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Chirurgia 2006 June;19(3):211-3

language: English

Surgical treatment for thoracic aortic aneurysm with total occlusion of carotid artery

Sezai A. 1, Shiono M. 1, Inoue T. 1, Hata M. 1, Negishi N. 1, Sezai Y. 1, Katayama Y. 2, Kanoh T. 2, Fukaya C. 2

1 Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
2 Department of Neurosurgery, Nihon University School of Medicine, Tokyo, Japan


A 69-year-old male had a 15-year history of asthma, hypertension, and diabetes mellitus. He diagnosed a thoracic aortic aneurysm and angina pectoris. Preoperative examination showed total occlusion of the right carotid artery. Angiography, ultrasonography and magnetic resonance angiography (MRA) revealed total occlusion of the right carotid artery. Cerebral single photon emission computed tomography showed a reduction of cerebral flow in area of the right middle cerebral artery. Magnetic resonance imaging (MRI) and CT revealed multiple cerebral infarctions. Preoperative examination suggested that carotid endarterectomy for total occlusion of the right carotid artery was impossible. Therefore, to maintain cerebral blood flow prior to cardiac surgery, anastomosis of the superficial temporal artery to the middle cerebral artery (STA-MCA anastomosis) was performed. Eight days after the surgery, open stent implantation and coronary artery bypass grafting were performed under deep hypothermic circulatory arrest with selective antegrade cerebral perfusion. The patient was discharged without cerebral complications. The number of patients such as the present one will increase. In the future, a larger number of patients should be investigated. Furthermore, heart surgeons alone cannot sufficiently evaluate the cerebral circulation, including cerebral monitoring, in many respects. They must cooperate with neurosurgeons.

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