Stent insertion for chronic total occlusion of the common carotid artery in a patient with Takayasu arteritis using an adjunctive retrograde approach via superficial temporal artery puncture: illustrative case.

backgroundTakayasu arteritis is a large-vessel vasculitis characterized by chronic inflammatory lesions that frequently lead to stenosis and occlusion of the common carotid artery (CCA). Endovascular revascularization for these inflammatory lesions is particularly challenging because the fibrotic and calcified vessel walls frequently hinder the passage of wires and catheters from a conventional antegrade approach. OBSERVATIONS: The authors report the case of a 57-year-old female with Takayasu arteritis who presented with a chronic total occlusion of the right CCA. The initial antegrade endovascular attempt resulted in wire dissection, necessitating an alternative strategy. They successfully performed retrograde recanalization via surgical cutdown of the superficial temporal artery (STA). A pull-through technique was utilized to establish a wire rail, which enabled safe and effective placement of the stent across the occluded segment. The patient's postoperative course was uneventful. LESSONS: The present case illustrates that a retrograde approach from the STA is a viable and effective alternative strategy for treating challenging CCA occlusions in patients with Takayasu arteritis. This technique expands the therapeutic options for complex vascular lesions that might otherwise be considered untreatable using conventional methods. https://thejns.org/doi/10.3171/CASE25897.