Complete brain protection during debranching thoracic endovascular aortic repair.

We describe the case of a 71-year-old man with an asymptomatic saccular-type thoracic aortic aneurysm and severe atheroma in the distal arch. As he had previously undergone coronary artery bypass grafting, we decided to perform thoracic endovascular aortic repair rather than open repair to avoid injury to the bypass grafts. Owing to severe atheroma, we completely blocked the native forward flow before deploying the endograft using percutaneous cardiopulmonary support, thus preventing perioperative stroke.