Timely Carotid Revascularization to Prevent Stroke After Left Common Carotid Artery Occlusion During TEVAR.

BACKGROUND: Proximal thoracic endovascular aortic repair extension near the aortic arch may compromise supra-aortic branch perfusion. CASE SUMMARY: A 41-year-old man with acute Stanford type B/DeBakey III aortic dissection had persistent chest pain despite anti-impulse therapy. A persistent type IA endoleak after the first thoracic stent graft required a second proximal extension. Completion angiography showed resolution of the endoleak but immediate loss of left common carotid artery opacification. Carotid duplex ultrasonography confirmed absent flow. Ultrasound-guided direct left common carotid artery access followed by chimney stenting restored antegrade carotid flow within 10 minutes, before any neurologic deficits developed. DISCUSSION: Immediate recognition and rapid bailout revascularization can prevent disabling cerebral ischemia after inadvertent left common carotid artery compromise. TAKE-HOME MESSAGE: Supra-aortic branch patency should be confirmed after proximal thoracic endovascular aortic repair extension, with prompt carotid bailout when compromise is detected.