Malposition of the Selective Antegrade Cerebral Perfusion Catheter Identified by Carotid Ultrasonography: A Case Report

ABSTRACT: Cerebral hypoperfusion can occur during aortic surgery. We present a case in which malposition of the selective antegrade cerebral perfusion (SACP) catheter was identified using carotid ultrasonography. A 66-year-old man underwent total arch replacement. SACP was initiated via the brachiocephalic artery following deep hypothermic circulatory arrest. However, right forehead regional oxygen saturation (rSO2) remained unchanged. Carotid ultrasonography revealed no blood flow in the right common carotid artery, suggesting catheter malposition into the right subclavian artery. After a slight catheter withdrawal, blood flow was restored, and rSO2 increased. Carotid ultrasonography, along with rSO2 monitoring, is recommended for evaluating cerebral perfusion during SACP.