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The endovascular treatment for acute type A dissection (ATAD) represents an alternative and emerging option in selected high surgical risk patients. We report a successful total endovascular ATAD repair occurred intraoperatively during transcatheter aortic valve implantation (TAVI) placement in 82 years old female, not fit for surgery in emergency setting. The presentation, the diagnostic evaluation, and the technique are discussed. This case would support the feasibility and efficacy of the stent graft technology to treat ATADs after evaluation of clinical, anatomical, and radiological parameters.

Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a “bovine” aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters.