Isolated Brachiocephalic Artery Dissection after Two-Debranching Thoracic Endovascular Aortic Repair: A Case Report

An 87-year-old man with a distal aortic arch aneurysm underwent 2-debranching thoracic endovascular aortic repair (TEVAR). Five days postoperatively, he developed sudden chest pain and syncope, with severe upper-limb hypoperfusion. Contrast-enhanced computed tomography (CECT) revealed brachiocephalic artery (BCA) dissection compressing the true lumen. Although conservative management was initially selected, percutaneous transluminal angioplasty with kissing bare-metal stents from the BCA to the right subclavian and right common carotid arteries was performed for recurrent hypotension. Postprocedural CECT confirmed satisfactory stent expansion and graft patency. This case demonstrates that careful monitoring enables timely intervention for BCA dissection after TEVAR.