{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T12:24:51Z","timestamp":1773663891785,"version":"3.50.1"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["JA Clin Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cerebral malperfusion during acute aortic dissection (AAD) surgery is a life-threatening event requiring prompt detection and intervention. We report a case of intraoperative extension of dissection into the brachiocephalic artery (BCA) detected by regional cerebral oxygen saturation (rSO\u2082) monitoring before cardiopulmonary bypass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 78-year-old man undergoing emergency total aortic arch replacement showed a sudden bilateral rSO\u2082 decline after anesthesia induction, corresponding to BCA extension on transesophageal echocardiography. rSO\u2082 recovered during selective cerebral perfusion but fell again during CPB weaning. Carotid duplex ultrasonography revealed collapse of the right common carotid artery due to false lumen expansion compressing the true lumen. Reanastomosis of the BCA restored cerebral oxygenation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the utility of multimodal monitoring\u2014rSO\u2082 trends, transesophageal echocardiography, and carotid duplex ultrasonography\u2014for detecting and managing cerebral malperfusion during AAD surgery. Early identification allows timely surgical revision and may improve neurological outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40981-026-00853-9","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T05:27:16Z","timestamp":1770701236000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative detection and management of cerebral malperfusion in acute aortic dissection using regional cerebral oxygen saturation monitoring: case report"],"prefix":"10.1186","volume":"12","author":[{"given":"Shinnosuke","family":"Miura","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroya","family":"Tsujimoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayami","family":"Shimomiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9161-0028","authenticated-orcid":false,"given":"Kenji","family":"Yoshitani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"issue":"3","key":"853_CR1","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1111\/jocs.15322","volume":"36","author":"T Cho","year":"2021","unstructured":"Cho T, Uchida K, Kasama K, Machida D, Minami T, Yasuda S, et al. Brachiocephalic artery dissection is a marker of stroke after acute type A aortic dissection repair. J Card Surg. 2021;36(3):902\u201308.","journal-title":"J Card Surg"},{"issue":"2","key":"853_CR2","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/S1053-0770(99)90114-3","volume":"13","author":"ML Blas","year":"1999","unstructured":"Blas ML, Lobato EB, Martin T. Noninvasive infrared spectroscopy as a monitor of retrograde cerebral perfusion during deep hypothermia. J Cardiothorac Vasc Anesth. 1999;13(2):244\u20135.","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"2","key":"853_CR3","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1177\/0267659110393298","volume":"26","author":"JT Faulkner","year":"2011","unstructured":"Faulkner JT, Hartley M, Tang A. Using cerebral oximetry to prevent adverse outcomes during cardiac surgery. 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Eur J Cardiothorac Surg. 2004;26(5):907\u201311.","journal-title":"Eur J Cardiothorac Surg"},{"issue":"5","key":"853_CR6","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1016\/j.jtcvs.2004.09.036","volume":"129","author":"G Sakaguchi","year":"2005","unstructured":"Sakaguchi G, Komiya T, Tamura N, Obata S, Masuyama S, Kimura C, et al. Cerebral malperfusion in acute type A dissection: direct innominate artery cannulation. J Thorac Cardiovasc Surg. 2005;129(5):1190\u201391.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"853_CR7","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1053\/j.jvca.2006.02.018","volume":"21","author":"JG Augoustides","year":"2007","unstructured":"Augoustides JG, Kohl BA, Harris H, Pochettino A. Color-flow doppler recognition of intraoperative brachiocephalic malperfusion during operative repair of acute type a aortic dissection: utility of transcutaneous carotid artery ultrasound scanning. 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Circ J. 2016;81(1):30\u20135.","journal-title":"Circ J"},{"key":"853_CR10","doi-asserted-by":"publisher","first-page":"1283703","DOI":"10.3389\/fcvm.2023.1283703","volume":"10","author":"HA Zaki","year":"2023","unstructured":"Zaki HA, Albaroudi B, Shaban EE, Alkahlout BH, Yigit Y, Elnabawy W, et al. Comparison between transthoracic echocardiography and transoesophageal echocardiography in the diagnosis of acute aortic dissection from an emergency perspective. A systematic review and meta-analysis. Front Cardiovasc Med. 2023;10:1283703.","journal-title":"Front Cardiovasc Med"},{"issue":"2","key":"853_CR11","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.jtcvs.2004.02.030","volume":"128","author":"E Neri","year":"2004","unstructured":"Neri E, Sani G, Massetti M, Frati G, Buklas D, Tassi R, et al. Residual dissection of the brachiocephalic arteries: significance, management, and long-term outcome. 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