Case Report: Hybrid retrograde transcarotid stenting for common carotid artery dissection secondary to acute type A aortic dissection.

BACKGROUND

Endovascular repair is an established option for symptomatic carotid artery dissection, particularly when hemodynamic compromise or embolic risk persists. In patients undergoing repair for acute type A aortic dissection (ATAAD), conventional transfemoral or transradial access may be prohibitive because of altered arch anatomy after graft reconstruction and stent-grafting. We report a postoperative left common carotid artery (CCA) dissection with focal aneurysmal dilatation and cerebral malperfusion following ATAAD repair. The lesion was treated using a hybrid strategy: direct cervical exposure for controlled retrograde transcarotid access and overlapping stent reconstruction.

CASE DESCRIPTION: A 48-year-old man presented with acute chest and back pain and was diagnosed with ATAAD. He underwent composite aortic repair including aortic root reconstruction, ascending and arch replacement, and descending aortic stent-grafting. Twenty-six hours postoperatively, he developed severe right-sided hemiparesis in the intensive care unit. Computed tomography angiography (CTA) showed near-occlusion of the mid-left CCA and delayed distal opacification. Given unfavorable transfemoral catheterization, emergent surgical cervical exposure enabled retrograde transcarotid sheath placement and deployment of three overlapping self-expanding stents. Final angiography demonstrated complete reperfusion (modified Thrombolysis in Cerebral Infarction, mTICI, grade 3) without intracranial distal embolization. Neurological recovery was favorable, with sustained stent patency and functional independence at follow-up.

CONCLUSION

Hybrid open retrograde transcarotid access may be considered a salvage option for postoperative CCA dissection after ATAAD repair when transfemoral access is prohibitive.