Combined antegrade-retrograde technique in urgent carotid stenting for true lumen compression after total arch replacement

Type A aortic dissection extending into the carotid arteries with true lumen compression poses a significant risk of cerebral hypoperfusion and neurological sequelae. This case report describes an elderly patient who developed an extension of the right common carotid artery dissection with associated true lumen compression immediately following total arch replacement for acute Type A aortic dissection. Urgent carotid stenting was performed using a combined antegrade-retrograde approach (trans carotid and trans radial approach) to restore blood flow. Postprocedural imaging confirmed patency without major complications. This technique highlights a viable salvage strategy for managing complex aortic dissections when traditional methods fail. A literature review discusses the combined antegrade-retrograde approach used in urgent carotid stenting, as well as the advantages of ultrasound in selecting the true lumen and its minimally invasive nature.