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Introduction Inadvertent carotid artery cannulation during central venous catheter (CVC) placement is a rare but serious complication, with risks of major cerebrovascular events. Endovascular techniques have emerged as safe alternatives interventions over open surgery, particularly in high-risk patients.Abstract C66 Figure 1Case Description A 74y male underwent right internal jugular CVC placement for intraoperative management. On the first postoperative day, he developed left hemiparesis. Cranial CT and cervical/cerebral angiotomography were performed, showing malpositioning of the CVC in the right common carotid, with a filling defect around the CVC suggestive of thrombus, without large-vessel occlusions amenable to mechanical thrombectomy. Endovascular-assisted catheter removal was proposed. With bilateral femoral artery catheterization, a FlowGate was positioned in the right common carotid, proximal to the CVC, and, through the contralateral access site, a HyperGlide was placed in the cervical segment of the right internal carotid artery. An occlusion test demonstrated adequate perfusion by the contralateral carotid. With both balloon catheters insufflated, the CVC was then externally removed under simultaneous irrigation with saline and aspiration through the FlowGate catheter, achieving successful recanalization without evidence of distal embolism. Hemostasis of the carotid puncture site was achieved with compression only.Abstract C66 Figure 2Conclusions Endovascular management using combining balloon tamponade offers a minimally invasive solution for iatrogenic carotid artery injury. Multidisciplinary collaboration and immediate imaging are critical to avoid catastrophic complications.Abstract C66 Figure 3Conflict of Interest No