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A rare case of insufficient right-sided unilateral cerebral perfusion during emergent aortic arch replacement in a patient with an acute aortic dissection is reported. On the basis of intraoperative monitoring using near-infrared spectroscopy, the insufficient perfusion of the contralateral hemisphere was detected and the bilateral perfusion was performed, which led to normalization of cerebral perfusion and an uncomplicated neurological outcome.

Insufficient unilateral cerebral perfusion during emergent aortic arch surgery