Delayed Left Carotid Artery Occlusion Due to Graft Displacement After Arch Replacement With Frozen Elephant Trunk

A 50-year-old man underwent emergency total arch replacement using the frozen elephant trunk technique for acute Stanford type A aortic dissection. On postoperative day 8, he developed visual field impairment, and brain magnetic resonance imaging revealed an acute ischaemic lesion in the right occipital lobe. His neurological condition subsequently stabilized, and he was discharged with residual visual field impairment and followed up on an outpatient basis. Eleven months after the surgery, he presented to the emergency department with transient dysarthria. Contrast-enhanced computed tomography (CT) demonstrated displacement and kinking of the prosthetic aortic graft, leading to occlusion of the left common carotid artery. Carotid duplex ultrasonography revealed retrograde flow in the left external carotid artery, supplying antegrade flow to the left internal carotid artery. Cerebral perfusion scintigraphy showed reduced blood flow in the left parietal lobe. Surgical revascularization was performed by creating a bypass from the aortic graft to the left common carotid artery. The postoperative course was uneventful, and the patient was discharged without new cerebral infarction or recurrent neurological deficits.