Carotid Artery Stenting by Direct Puncture of the Aortic Arch Graft during Total Arch Replacement

We report a unique case of carotid artery stenting (CAS) conducted via direct puncture of an aortic arch graft in a patient who underwent total arch replacement (TAR), complicated by carotid artery dissection.

A 72-year-old woman underwent TAR for an ascending aortic aneurysm. Aortic dissection extending to the right carotid artery was detected immediately after the aortic arch graft anastomosis, which resulted in severe stenosis and decreased cerebral perfusion. Therefore, urgent revascularization was deemed necessary. The aortic arch graft was directly punctured, followed by the placement of 3 stents to seal the dissection. Postoperative imaging confirmed the restoration of blood flow without ischemic complications. The patient, who recovered without neurological deficits or cardiosurgical complications, has remained event-free for 3 years after the intervention.

Direct puncture of the aortic arch graft provides a reliable and rapid access route for CAS in patients undergoing carotid artery dissection following TAR. This method may serve as an alternative when conventional access is difficult. Antithrombotic therapy should be strictly controlled to avoid procedure-related complications.