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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2023; 07(02): 133-135
DOI: 10.1055/s-0042-1755610
Short Communication

Rescue of Compromised Cerebral Circulation in Hybrid TEVAR for Type B Aortic Dissection

Karthikeyan Muthugounder Athiyappan 
1   Department of Interventional Radiology, Kovai Medical Centre, Coimbatore, Tamil Nadu, India
,
Mathew Cherian
1   Department of Interventional Radiology, Kovai Medical Centre, Coimbatore, Tamil Nadu, India
,
Santhosh Poyyamoli 
1   Department of Interventional Radiology, Kovai Medical Centre, Coimbatore, Tamil Nadu, India
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Clinical Details

A 60-year-old female presented with complicated type B aortic dissection (end organ ischemia), with location of entry tear just distal to origin of left subclavian artery ([Fig. 1A]). She had a hypoplastic right vertebral artery ending as posterior inferior cerebellar artery, with dominant left vertebral artery solely constituting the vertebrobasilar circulation ([Fig. 1B]). Hence, she was planned for emergency left subclavian artery to common carotid artery (CCA) bypass, followed by hybrid thoracic endovascular aortic repair (TEVAR).

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Fig. 1 (A) Complicated type B aortic dissection with location of entry tear just distal to origin of left subclavian artery. (B) CT showing hypoplastic right vertebral artery which terminates as posterior inferior cerebellar artery (PICA) and dominant left vertebral artery. (C) Pigtail aortogram following carotid-subclavian bypass showing patent carotid-subclavian bypass and nonvisualization of left vertebral artery. (D) Right subclavian angiogram confirming the right vertebral artery terminating as PICA, with no contribution to the vertebrobasilar system. (E, F) Right common carotid angiogram showing complete retrograde filling of basilar artery (arrow) through dominant posterior communicating artery (Pcom).


Publication History

Article published online:
12 September 2022

© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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