Hemorrhagic cardiac tamponade is one of potentially fatal complications of endovascular intervention. Usually it is because of perforation of heart or rupture of aorta. Cases of pericardial effusion without any arterial or heart injury are rare. Case presentation we reported is a clinical case of cardiac arrest due to tamponade in a patient with DeBakey type I aortic dissection (AD) undergoing thoracic aortic stent implantation. In the early phase of the procedure, hemodynamic changes of increased central venous pressure and decreased blood pressure - by tamponade were noticed but unrecognized and lead to cardiac arrest ultimately. During resuscitation, cardiac tamponade was suspected and confirmed by transesophageal echocardiography (TEE). The patient was successfully resuscitated after pericardiocentesis. Conclusion This case of cardiac tamponade emphasizes the importance of vigilant clinical and echo assessments, efficient multidisciplinary teamwork in deal with the rare but severe complication.