Purpose: To present stent-graft treatment of parietal thrombus in the ascending aorta. Case Report: A 64-year-old man with no history of vascular disease developed a right cerebral hemisphere transient ischemic attack and was diagnosed with mural thrombosis of the ascending aorta involving the greater curvature just proximal to the origin of the innominate artery. He was treated for 2 months with anticoagulants, but new imaging studies showed significant increase in the size of the thrombus and an irregular aspect. The thrombus was excluded from the aortic blood flow by deployment of a custom-made stent-graft in the ascending aorta, with embolic protection of the right internal carotid artery. At 6 months, the patient was well, and the thrombus in the ascending aorta appears to be completely excluded by the stent-graft. Conclusion: In highly selected cases, custom-made thoracic stent-grafts may be used for stabilization and exclusion of symptomatic ascending aorta parietal thrombosis to prevent progression and recurrent embolization.