References:
  1. Malaisrie SC, Szeto WY, Halas M, Girardi LN, Coselli JS, Sundt tm et al. « 2021 The American Association for Thoracic Surgery Expert Consensus Document: Surgical Treatment of Acute Type A Aortic Dissection ». The Journal of Thoracic and Cardiovascular Surgery 2021; 162: 735-758.e2.
  2. Berretta P, Trimarchi S, Patel HJ, Gleason TG, Eagle KA, Di Eusanio M. « Malperfusion Syndromes in Type A Aortic Dissection: What We Have Learned from IRAD ». Journal of Visualized Surgery 2018 ; 4 : 65‑65.
  3. Guihaire J, Langanay T, Launey Y, Verhoye JP « Dissection aortique aiguë de type A compliquée d’accident vasculaire cérébral grave : fallait-il l’opérer ? », Chirurgie Thoracique et Cardio-Vasculaire 2015, 6.
  4. Thomalla G, Cheng B, Ebinger M, Hao Q, Tourdias T, Wu O et al. « DWI-FLAIR Mismatch for the Identification of Patients with Acute Ischaemic Stroke within 4·5 h of Symptom Onset (PRE-FLAIR): A Multicentre Observational Study ». The Lancet Neurology 2011; 10: 978‑86
  5. Tsukube T, Haraguchi T, Okada Y, Matsukawa R, Kozawa S, Ogawa K et al. « Long-Term Outcomes after Immediate Aortic Repair for Acute Type A Aortic Dissection Complicated by Coma ». The Journal of Thoracic and Cardiovascular Surgery 2014; 148: 1013‑19.

FIGURE LEGENDS

Figure 1: Arterial phase, contrast-enhanced CT scan (cervical axial sections) showing extension of the aortic dissection to the supra-aortic trunks. The right common carotid artery and the right internal carotid artery are not opacified. The left common artery is dissected and thrombosed with a left internal carotid artery opacified probably through retrograde collateral flow. Both vertebral arteries are patent.
Figure 2. Brain Magnetic Resonance Imaging, b1000 diffusion sequence signal revealing a limited recent cortical ischemic injury (white arrow) in the right internal carotid territory. The remaining brain parenchyma is viable.
Figure 3. A) Contrast-enhanced CT scan showing type A acute aortic dissection. The right coronary artery arises from the false lumen with a dynamic obstruction of the left main stem. B) At the abdominal level, the splanchnic arteries arise from the true lumen with no sign of mesenteric ischemia.
Figure 4. A) Non-contrast enhanced MR Angiography (ARM 3D TOF) showing integrity of the polygon of Willis and its perfusion through B) the vertebral arteries, allowing the maintenance of an antegrade flow in both Sylvian arteries.

VIDEO LEGENDS

Video 1 . Contrast-enhanced CT scan from the abdominal aorta to the supra-aortic vessels showing type A aortic dissection and its extensions to the various arterial branches. The right common carotid and right internal carotid arteries are not opacified. The left common carotid artery is dissected and thrombosed. The left internal carotid artery is partially opacified retrogradely. Both vertebral axes are patent.
Video 2. 3D TOF Magnetic Resonance Imaging angiogram showing no visibility of the right carotid artery within the carotid canal. On the other hand, a complete anastomotic arterial circle of the base was identified, the blood flow towards its anterior portion being provided by vertebral arteries. The right middle cerebral artery was less intense in signal due to the underlying cervical involvement.