Emergency Retrograde Left Common Carotid Artery Stenting after Thoracic Endovascular Aortic Repair with Regional Cerebral Oxygen Saturation Monitoring: Report of Two Cases

Objective: Two cases in which emergency retrograde stenting were performed for occlusion of the left common carotid artery orifice that occurred during thoracic endovascular aortic repair are reported.Case Presentations: In males in their 70s with thoracic aortic aneurysm, oxygen saturation dropped in the left cerebrum immediately after deployment of the thoracic aortic stent graft under general anesthesia. The stent graft obstructed the orifice of the left common carotid artery, and recanalization was achieved by direct puncture of the cervical left common carotid artery and placing a balloon expandable stent at the orifice of the left common carotid artery. No postprocedural neurologic deficits were observed.Conclusion: Retrograde stenting of the orifice of the left common carotid artery is effective for thoracic aortic stent graft migration, and regional cerebral oxygen saturation is an important index. The cases are worth reporting as neurointerventionist may also be required to perform the procedure, which is usually performed by vascular surgeons.