{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:28:06Z","timestamp":1786116486819,"version":"build-2736575974"},"reference-count":8,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Acute type-A aortic dissection is a life-threatening emergency requiring prompt surgical intervention. However, the management of patients presenting with concomitant intracerebral haemorrhage remains challenging, as the risk of neurological deterioration during surgery must be balanced against the risk of fatal aortic rupture. We report the rare case of a 68-year-old patient diagnosed with acute intracerebral haemorrhage involving the parietal lobe and right frontal region in association with acute type-A aortic dissection. Due to the neurological condition, a delayed surgical strategy was chosen. Six weeks after the initial diagnosis, supracoronary hemiarch replacement of the ascending aorta was successfully performed without postoperative neurological complications. This case highlights the complexity of decision-making in patients with simultaneous acute aortic pathology and intracranial bleeding. This educational report emphasises that immediate surgical repair remains the standard of care. The delayed strategy described here was dictated by an absolute contraindication to anticoagulation and reflects an exceptional, individualised management approach rather than a general therapeutic recommendation.<\/jats:p>","DOI":"10.3390\/jcdd13080371","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T09:46:38Z","timestamp":1786009598000},"page":"371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute Type A Aortic Dissection with Concomitant Intracerebral Haemorrhage: A Therapeutic Dilemma Regarding the Timing of Surgery"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7753-5501","authenticated-orcid":false,"given":"Yoganiranjana","family":"Dharuman","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borko","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Helios Hospital Siegburg, 53721 Siegburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Sirat","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Helios Hospital Siegburg, 53721 Siegburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko","family":"Doss","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Helios Hospital Siegburg, 53721 Siegburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7434","DOI":"10.1038\/s41598-020-64299-4","article-title":"Incidence of acute type A aortic dissection in emergency departments","volume":"10","author":"Wundram","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s40560-018-0287-7","article-title":"Management of acute aortic dissection and thoracic aortic rupture","volume":"6","author":"Fukui","year":"2018","journal-title":"J. Intensive Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e080870","DOI":"10.1136\/bmj-2024-080870","article-title":"Acute aortic syndrome","volume":"386","author":"Goodacre","year":"2024","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.15420\/usc.2022.36","article-title":"Risk Factors for Aortic Dissection","volume":"17","author":"Kano","year":"2023","journal-title":"US Cardiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1111\/jocs.16332","article-title":"Type-A acute aortic dissection complicated by parenchymal hemorrhagic stroke: Timing of surgery for a rare presentation of aortic dissection","volume":"37","author":"Hartley","year":"2022","journal-title":"J. Card. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1186\/1752-1947-7-223","article-title":"The CARE guidelines: Consensus-based clinical case reporting guideline development","volume":"7","author":"Gagnier","year":"2013","journal-title":"J. Med. Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"ezad426","DOI":"10.1093\/ejcts\/ezad426","article-title":"EACTS\/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"65","author":"Czerny","year":"2024","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e032094","DOI":"10.1161\/JAHA.123.032094","article-title":"Optimal Timing for Resumption of Anticoagulation After Intracranial Hemorrhage in Patients with Mechanical Heart Valves","volume":"13","author":"Barra","year":"2024","journal-title":"J. Am. Heart Assoc."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/371\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T10:25:53Z","timestamp":1786011953000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/371"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":8,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcdd13080371"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13080371","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]}}}