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Repair of right carotid artery pseudoaneurysm in a patient with hostile aortic arch through left ventricular approach.

We describe the case of an 81-year-old male who presented with a rapidly expanding neck hematoma from a common carotid artery pseudoaneurysm. Percutaneous repair using the right femoral artery approach was unsuccessful due to a hostile aortic arch. Using a small left thoracotomy and antegrade left ventricular access to the ascending aorta, a covered stent was successfully delivered at the site of the pseudoaneurysm. Our case provides proof-of-principle that complex carotid interventions can be performed expediently through a left ventricular approach in patients with hostile aortic arch.