Emergent thoracic endovascular aortic repair via the left common carotid artery: A case report

A 75-year-old woman with prior coronary bypass, endovascular aortic repair, and femoral bypass presented with a ruptured thoracic aortic aneurysm and type Ib endoleak. Conventional access routes were unsuitable due to severe calcification and tortuosity. The left common carotid artery was selected after confirming cerebral ischemia tolerance with a Matas test. A stent-graft was successfully deployed using a pull-through technique without complications. The patient recovered fully without neurological deficits. This case highlights the feasibility of carotid access for emergent endovascular repair and suggests that a simple Matas test may be sufficient for assessing cerebral tolerance in urgent settings.