Stanford type A acute aortic dissection (AAD) is associated with carotid artery dissections (CADs). We report two cases of carotid artery stenting (CAS) for symptomatic CAD after ascending aortic replacement (AAR) for AAD.Case Presentation: Case 1: A 51-year-old man with AAD was transferred to our institute. He had no notable paralysis symptoms on initial presentation. However, after AAR for AAD was performed, left paralysis developed within a few hours.Emergency angiography revealed right CAD and pseudo-occlusion. CAS was performed successfully using intravascular ultrasound (IVUS). He was transferred to a rehabilitation hospital with a modified Rankin Scale (mRS) score of 2.Case 2: A 55-year-old man underwent AAR for AAD, but asymptomatic left CAD remained. Two weeks after the operation, he presented with slight signs of aphasia. Aspirin was prescribed and follow-up was performed, but his symptoms did not improve.He underwent magnetic resonance imaging in our department, which revealed acute cerebral infarction on the left pars opercularis and an artery-to-artery embolism from CAD. CAS was performed via the retrograde approach with direct puncture of the normal left common carotid artery using IVUS. He was discharged with no complications and a mRS score of 1. Conclusion:IVUS can be useful for CAS to confirm the true lumen and extension of long CAD lesions developing from AAD.Keywords▶ carotid artery stenting, carotid artery dissection, Stanford type A aortic dissection, intravascular ultrasound Case Presentation Case 1Patient: A 51-year-old man. Complaint: Left hemiplegia. Medical history: Hypertension. Present illness: Suddenly, dimmed vision and weakness were developed and he was transported to his previous hospital by ambulance. On arrival, consciousness was clear and there was no obvious limb paralysis on gross motor movement. The blood pressure was 132/88 mmHg and electrocardiography demonstrated no abnormality. However, detailed examination led to a diagnosis of AAD. The patient was referred to our hospital and emergency AAR was performed at the Department of Cardiovascular Surgery. Immediately after surgery, there was no paralysis of the limbs, but incomplete paralysis of the left upper and lower limbs was suspected 7 hours after surgery, leading to complete paralysis 9 hours after surgery. The patient was referred to the Department of Neurosurgery. No acutephase lesion was found on computed tomography (CT). Three-dimensional (3D) CT angiography (3D-CTA) revealed CAD involving the origin of the brachiocephalic This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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