Multiple stenting using anchoring technique with balloon guiding catheter for common carotid artery dissection after aortic arch replacement: A case report

INTRODUCTION AND IMPORTANCE: Common carotid artery (CCA) dissection is a minor complication during aortic arch replacement (AAR). Although endovascular treatment can be considered for symptomatic CCA dissection despite internal therapy, no report has mentioned about carotid stenting for CCA dissection after vascular graft replacement. CASE PRESENTATION: The patient was a 68-year-old man presented with recurrent transient right hemiparesis. CECT and arteriography showed the progressive CCA dissection associated with AAR and decreased cerebral blood flow. MRI showed no evidence of infarction. Epilepsy, electrolyte abnormalities, hypoglycemia, spinal cord disease were considered as differential diagnoses of transient paralysis, but all were negative. Considering these findings, we diagnosed the patient with transient ischemic attacks (TIAs) caused by CCA dissection. He was treated with multiple stents deployed through vascular grafts using anchoring technique with balloon guiding catheter. Angiography demonstrated reconstitution of the CCA and internal carotid artery 1.5 years after the intervention, and no further TIAs were observed. MRI scan showed no evidence of infarction. CLINICAL DISCUSSION: After AAR, the alteration of anatomy and lack of elasticity of vascular grafts make it quite difficult to access lesions. The adoption of a distal access catheter (DAC) and balloon inflation of a guiding catheter (BGC) are useful approaches. CONCLUSION: To our knowledge, this is the first case report of successful multiple carotid stenting through vascular grafts for the treatment of CCA dissection. The main take-away lessons are the following three. • The treatment for CCA dissection after aortic arch replacement is challenging. • Anchoring technique using BGC is useful to resolve the difficulty by the alteration of anatomy and lack of elasticity of vascular grafts. • Multiple stenting through vascular grafts was highly tolerable and achieved the excellent long-term outcome.