Endovascular ascending aortic pseudoaneurysm repair under image fusion guidance and transcranial Doppler monitoring

We describe a 78-year-old woman with a large ascending aortic pseudoaneurysm who underwent thoracic endovascular aortic repair under intraoperative image fusion guidance and real-time transcranial Doppler (TCD) monitoring. TCD monitoring revealed a total of 419 microembolic signals throughout the procedure, with the majority occurring as the first stent graft crossed the ascending aorta. Two days later, she underwent endovascular repair of a graft type IA endoleak. We highlight the role of image fusion guidance and TCD monitoring in enabling successful thoracic endovascular aortic repair in an elderly woman and in identifying procedural areas of improvement to minimize stroke risk. (J Vasc Surg Cases Innov Tech 2022;8:425-8.)

Automated summary

We report a case of a 78-year-old woman with a large ascending aortic pseudoaneurysm who underwent thoracic endovascular aortic repair with intraoperative image fusion guidance and real-time transcranial Doppler monitoring. TCD monitoring revealed a significant number of microembolic signals, with the majority occurring during the crossing of the ascending aorta by the first stent graft. Two days later, the patient underwent endovascular repair of an IA endoleak. The article highlights the importance of image fusion guidance and TCD monitoring in successful thoracic endovascular aortic repair in an elderly woman, as well as identifying areas for procedural improvement to minimize the risk of stroke.