Case report: left monoplegia in acute type B aortic dissection

Acute type B aortic dissection (ATBAD) with malperfusion is a devastating complication. Especially, the spinal cord ischemia with ATBAD is very rare (3% of total malperfusion cases). Despite the possibility of various arterial involvement in ATBAD, cases of monoplegia due to spinal cord ischemia are extremely rare. Furthermore effective treatments for malperfusion induced spinal cord ischemia have not been established yet. We presented a case of a 62-year-old man with a sudden onset of chest pain and numbness and weakness of the left lower extremity. Follow up CT demonstrated ATBAD starting from below the left subclavian artery to the level of iliac bifurcation without distal reentry, involving malperfusion of the left renal, left intercostal and left lumbar arterial branches. Deciding on endovascular fenestration approach under considering his condition and comorbidity, the right common femoral artery was catheterized and a 5Fr sheath catheter was positioned into the true lumen (Cook Medical, IN, USA). After confirming the catheter was within the compressed true lumen, then aortic fenestration ballooning was performed to enlarge a tearing site by using 12-mm and 20-mm diameter balloons (Boston Scientific, Natick, Mass). The final angiography was demonstrated increased flow in the true lumen of descending aorta with good patency of the left renal artery where no flow had been observed. And enhanced CT confirmed the recovery of flow to the left intercostal and left lumbar branches. Finally the patient achieved the complete recovery of sensory and motor function of his left leg (His preoperative motor grade was 5/0). On postoperative day 3, he walked using a q-cane and now is being followed up on an outpatient basis without no complications. So, we would like to introduce this rare care of left lower monoplegia with ATBAD and suggest endovascular fenestration can be an effective treatment option to treat spinal cord ischemia in ATBAD.