The authors report a case of tracheo-innominate artery fistula secondary to tracheal perforation in an 18-year-old patient who is tetraplegic following cervical trauma. The patient had a very long tracheal stenosis, secondary to tracheostomy, which was managed by laser resection and a Gianturco stent. One of the anterior struts of the stent had eroded the trachea and the posterior wall of the innominate artery. Surgical management consisted of arterial resection, a longitudinal tracheal split incision to withdraw the stent and placement of a Montgomery T-tube. The patient has no respiratory discomfort 7 months after surgery.