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Prevention of Stroke Related to Ascending Aortic and Aortic Arch Atherothrombotic Material: Review

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Cardio-aortic and Aortic Surgery

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Summary

The etiology of stroke is multifactorial. In addition to extracranial or intracranial cerebrovascular disease (or both) and cardiac emboli, atherosclerotic debris in the ascending and arch aorta is now a well established cause of perioperative stroke. Intraoperative findings of a calcified or thickened aorta most often alert the surgeon to a problem. The risk of stroke is more closely correlated with the presence of mobile intraluminal debris that has been dislodged by aortic manipulation for cannulation or graft placement. Visual inspection and palpation is notoriously unreliable in this regard. Transesophageal and epiaortic ultrasonography are easily performed and provide rapid, accurate identification and grading of aortic atherosclerotic disease. Management strategies vary based on the extent of aortic disease and the underlying cardiac pathology. Appropriate management strategies may include one or more of the following: alteration of the aortic cannulation site, cannulation of the femoral or axillary artery, using modified aortic cannulas, the “no-touch” technique, fibrillatory arrest, expanded use of arterial grafts and alternative placement of proximal anastomotic sites, use of an endoaortic occlusion balloon, deep hypothermic circulatory arrest, ascending aortic/arch replacement, and radical débridement with aortic endarterectomy.

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  1. Department of Thoracic and Cardiovascular Surgery, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA, 01805, USA

    Richard S. D’Agostino

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  1. Richard S. D’Agostino
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  1. Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Shiaki Kawada M.D. , Toshihiko Ueda M.D.  & Hideyuki Shimizu M.D. ,  & 

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D’Agostino, R.S. (2001). Prevention of Stroke Related to Ascending Aortic and Aortic Arch Atherothrombotic Material: Review. In: Kawada, S., Ueda, T., Shimizu, H. (eds) Cardio-aortic and Aortic Surgery. Keio University International Symposia for Life Sciences and Medicine, vol 7. Springer, Tokyo. https://doi.org/10.1007/978-4-431-65934-1_11

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  • DOI: https://doi.org/10.1007/978-4-431-65934-1_11

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