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We used left common carotid artery cannulation for repair of type A aortic dissection in 2 patients for whom both femoral artery and axillary artery cannulation were thought to be more dangerous, due to dissection of the brachiocephalic trunk and left subclavian artery in association with abdominal stenosis. Before performing end-to-side anastomosis, we attached a small partial clamp to the left common carotid artery, thereby maintaining adequate cerebral blood flow during perfusion. To date, neither of our patients has experienced neurologic complications related to this procedure. We believe that left common carotid artery cannulation for type A dissections is useful when dissection of the brachiocephalic trunk and left subclavian artery is found in association with abdominal or femoral artery stenosis. To the best of our knowledge, these 2 cases are the 1st described in the medical literature. (Tex Heart Inst J 2003;30:128-9)