Objective: To evaluate the early efficacy and safety of simultaneous aortic and carotid repair in acute Stanford type A aortic dissection (ATAAD) extending to the cervico-cerebral vessels. Methods: Between October 2023 and May 2025, 18 consecutive ATAAD patients (14 men, 4 women; median age 53 years) with severe stenosis or occlusion of the common carotid artery (CCA) were enrolled. All operations were performed within 24 h of diagnosis by a joint cardiac-cerebrovascular team. A single-stage procedure combined standard proximal aortic repair with neck-incision carotid reconstruction. Proximal procedures: ascending replacement (n = 12) or Bentall (n = 6); total arch replacement used the Sun′s procedure in every patient. Carotid management: isolated left CCA replacement (n = 6), isolated right (n = 3), or bilateral (n = 9). Antegrade cerebral perfusion (ACP) was delivered at 28–32 °C for a mean circulatory-arrest time of 21.6 ± 9.3 min (unilateral 15, bilateral 3) with continuous cerebral oximetry. Results: Technical success was 100 %; no intra-operative death occurred. In-hospital mortality was 1 (5.6 %) due to massive cerebral infarction. New permanent neurological deficit occurred in 1 patient (5.6 %, hemiplegia) and transient dysfunction in 3 (16.7 %). Median ICU stay was 2.4 days (IQR 2.1, 7.3). All carotid grafts remained patent at discharge. Conclusion: Under selective circulatory-arrest times and individualized brain-protection protocols, single-stage thoracic aortic repair plus neck-incision carotid reconstruction is a safe and feasible strategy for ATAAD involving the cervico-cerebral vessels, significantly reducing early neurological complications and improving early outcomes.
