Purpose Ascyrus Medical Dissection Stent (AMDS) is a novel uncovered hybrid stent graft developed to be used in Acute type A aortic dissection (ATAAD). Herein we present management of a complex ATAAD with AMDS who presented with significant lower limb and coronary malperfusion and a complete luminal obstruction in a previously implanted Thoracic Endovascular Aortic Repair (TEVAR). Case Presentation & surgical management A 58-year-old male presented with acute chest pain and left lower limb hemiplegia with a history of TEVAR for a traumatic type B aortic dissection 15 years prior. ATAAD was confirmed with a tear in the 63mm ascending aorta extending to the aortic root involving right and left coronary ostia with further extension to distal left main and a TOE showing a severe aortic regurgitation. The dissection extended into innominate and left common carotid arteries and created a dissection flap over the proximal end of the TEVAR stent causing a stent lumen blockage. Antegrade dissection propagated towards the left common iliac via a created false lumen external to TEVAR stent. Patient underwent emergent surgical repair with Bentall procedure and deployment of small AMDS landed distally inside the TEVAR stent with good effect and grafts to Left Anterior Descending (LAD) and Optuse Marginal (OM). Patient was admitted in ICU with a plan for delayed sternal closure. Patient’s chest was closed in theatre day 2 and extubated 3 days after chest closure with stable hemodynamics and no inotropes without end organ damage with intact bilateral lower limb perfusion which suggests sealing of the false lumen. Patient progress is only up to 7 days after the index operation by the time of this report. Conclusions AMDS is a feasible, reproducible and promising device which induces positive aortic remodeling and can be landed inside a TEVAR stent with effective management of malperfusions associated with ATAAD. Attention to decision making in complex ATAAD is of great important.