Endovascular treatment of innominate artery occlusion with simultaneous vertebral and carotid artery distal protection: case report.

Abstract:

OBJECTIVE:Atherosclerotic stenosis or obstruction of the innominate artery is rare. Traditional surgical management is a technically demanding intervention with acceptable, but not negligible, rates of morbidity and mortality. Endovascular approaches to supraaortic lesions have been successful and are now the preferred treatment for stenoses of the brachiocephalic vessels. The use of cerebral protection devices in subclavian and innominate interventions is less established. CLINICAL PRESENTATION:A 58-year-old woman had Takayasu giant cell arteritis with a history of a left middle cerebral artery stroke 3 weeks after undergoing placement of a left common carotid artery (CCA) stent and right innominate artery stent in 1998. She recently presented with worsening dizziness, ataxia, and right arm numbness and was referred to the endovascular neurosurgery service for management. INTERVENTION:Initial angiography revealed left CCA stenosis and right innominate occlusion. The patient initially underwent left CCA angioplasty, planned as a staged procedure. This was followed by recanalization of the right innominate artery through an approach using both femoral arteries and the right brachial artery. This 3-site technique allowed simultaneous distal protection of both the right cervical vertebral and carotid arteries. CONCLUSION:Reopening a chronically occluded innominate artery risks an embolic shower through both the right vertebral and carotid arteries. Using multiple sites of arterial access, distal protection devices can be deployed in both the cervical vertebral and carotid arteries to reduce the risk of stroke.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Stiefel MF,Park MS,McDougall CG,Albuquerque FC

doi

10.1227/01.NEU.0000367549.33541.34

subject

Has Abstract

pub_date

2010-04-01 00:00:00

pages

E843-4; discussion E844

issue

4

eissn

0148-396X

issn

1524-4040

pii

00006123-201004000-00038

journal_volume

66

pub_type

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