Thrombectomy and reconstruction of the left vertebral artery after total arch replacement: never give up on postoperative stroke

Gen Thorac Cardiovasc Surg. 2020 May;68(5):534-537. doi: 10.1007/s11748-019-01106-6. Epub 2019 Mar 14.


The patient was a 64-year-old man who had aortic regurgitation, ischemic heart disease, a transverse aortic aneurysm, and an abdominal-common iliac aneurysm. Concomitant operations including aortic valve replacement, coronary artery bypass grafting, and total aortic arch replacement with elephant trunk technique were performed successfully. The patient developed postoperative cardiac tamponade on the 5th postoperative day, resulting in bulbar palsy due to occlusion of the dominant left vertebral artery. Thrombectomy of the vertebral artery with reconstruction by a saphenous vein was performed. The patient's neurological symptoms improved after the operation. Revascularization of ischemic stroke may yield neurological improvement even in patients after cardiovascular surgery.

Keywords: Frozen elephant trunk; Stroke; Total arch replacement; Vertebral artery.

Publication types

  • Case Reports

MeSH terms

  • Aortic Aneurysm, Thoracic / complications
  • Aortic Aneurysm, Thoracic / surgery
  • Aortic Valve Insufficiency / complications
  • Aortic Valve Insufficiency / surgery
  • Blood Vessel Prosthesis Implantation / methods
  • Brain Ischemia / etiology
  • Brain Ischemia / surgery*
  • Bulbar Palsy, Progressive / etiology
  • Cardiac Tamponade / etiology
  • Coronary Artery Bypass
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / complications
  • Myocardial Ischemia / surgery
  • Plastic Surgery Procedures
  • Postoperative Complications / etiology
  • Stroke / etiology
  • Stroke / surgery*
  • Thrombectomy*
  • Thrombosis / etiology
  • Thrombosis / surgery*
  • Vertebral Artery / surgery*