Surgical Management of Type A Aortic Intramural Hematoma With Cerebral Malperfusion: Carotid Revascularization and Arch Replacement

Acute type A aortic dissection (ATAAD) with cerebral malperfusion presents a significant surgical challenge. This report describes a novel approach involving initial right carotid artery repair with interposition grafting and selective cerebral perfusion, followed by total aortic arch replacement using deep hypothermic circulatory arrest. This strategy optimized cerebral perfusion and facilitated successful aortic repair. The patient experienced partial neurologic recovery despite an initial ischemic stroke with hemorrhagic conversion. This case highlights the importance of a tailored, multidisciplinary approach in patients with complex ATAAD.