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

  • Chikashi Aoki
  • Ikuo FukudaEmail author
  • Ken-ichi Watanabe
  • Yoshiaki Saito
  • Anan Nomura
  • Satoshi Taniguchi
Case Report


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.


Total arch replacement Frozen elephant trunk Vertebral artery Stroke 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

11748_2019_1106_MOESM1_ESM.tiff (1.5 mb)
Preoperative CT. a, 3D CT of the aorta; b, transverse aortic arch aneurysm; c, abdominal aneurysm; d, right common iliac artery aneurysm (TIFF 1521 KB)
11748_2019_1106_MOESM2_ESM.tiff (1.5 mb)
Intraoperative fluoroscopy during left vertebral artery thrombectomy. The white arrow indicates the inflated Fogarty 4F balloon at the middle portion of the left vertebral artery (a) and at the proximal portion of the left vertebral artery (b); c, extracted thrombi (TIFF 1521 KB)


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Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Department of Thoracic and Cardiovascular SurgeryHirosaki University Graduate School of MedicineHirosakiJapan

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