# Transthoracic Echocardiogram Guided Hemodynamic Management to Maintain Cerebral Perfusion in an Extracranial–Intracranial Bypass Case: Case Report

## TL;DR

A 70-year-old man with a brain bypass surgery complication was treated with blood pressure adjustments guided by heart imaging to restore brain blood flow.

## Contribution

Demonstrates the use of transthoracic echocardiography to guide hemodynamic management for cerebral perfusion after a failed bypass.

## Key findings

- Induced hypertension improved aphasia following bypass occlusion.
- Transthoracic echocardiography was used to optimize blood pressure in the presence of left ventricle outflow tract obstruction.
- Serial monitoring helped maintain cerebral perfusion in a complex clinical scenario.

## Abstract

A 70-year-old man with transient ischemic attacks (TIAs) due to left internal carotid artery (ICA) occlusion underwent external carotid to ICA bypass which occluded postoperatively. He developed aphasia which resolved with induced hypertension optimized by using serial transthoracic echocardiography in the setting of left ventricle outflow tract obstruction.