Multiple carotid stenting for extended thoracic aorta dissection after initial aortic surgical repair

Acute aortic dissection is one of the most common catastrophes affecting the aorta. Aortic branch occlusion occurs in up to one third of patients with aortic dissection and is associated with increased risk for early death and serious complications. A 67-year-old man without history of cardiovascular disease was referred to our center for acute aortic type A dissection and was treated with a 28-mm Vasculteck prosthesis. During the early postoperative period, he felt left hemiparesis, and an angio-computed tomography showed a progression of the dissection to the right common carotid artery and left brachiocephalic trunk: the abdominal aorta with the celiac trunk. We felt that the patient should receive conservative management, except for the carotid involvement, for which an endovascular approach was planned. After carefully engaging the carotid ostia with a modified no-touch technique, a self-expandable stent and a balloon-expandable stent were deployed to seal the left common and internal carotid artery dissection, whereas two self-expandable stents were implanted within the right internal carotid artery. Angiographic control demonstrated complete sealing of the carotid dissections. The patient recovered quickly after the intervention and was discharged after 2 days without any neurologic or vascular complication. The patient did extremely well at two 3-month follow-ups, and coverage of the descending thoracic aorta dissection was scheduled to be performed in the next 2 months. This case suggests that endovascular techniques may offer a reliable and effective answer to extended dissections, helping decrease the risk for neurologic or visceral complications and reducing the operative risk for further complete surgical or endovascular aortic repair.