Cerebrovascular complications of aortic arch surgery

Ischemic strokes in the brain and the spinal cord are dreaded complications of aortic arch surgery. The etiology of these strokes is most typically embolic from atheromatous material but compression or dissection of branch vessels or hypoperfusion (particularly of radicular spinal branches) may be associated with increased stroke risk. Various techniques including partial left heart bypass with hypothermic circulatory arrest and retrograde or anterograde cerebral perfusion along with lumbar cerebrospinal fluid drainage may decrease the risk of neurovascular complications of aortic arch or thoracic aortic surgery. The risks of neurovascular complications with endovascular stenting of the aorta are unclear at this time.