Bilateral brachial pull-through technique for stenting in a patient with stenosis of the vertebral artery origin: technical case report

Abstract

Stenting for stenosis of the proximal vertebral artery (VA) is commonly performed via a femoral approach. However, iliofemoral occlusive disease such as arteriosclerosis obliterans sometimes prevents safe transfemoral access. In certain situations where both femoral access and ipsilateral brachial access are difficult because of a concomitant vascular diseases or particular anatomic setting, a contralateral brachial approach using the brachiobrachial pull-through technique may allow efficient and accurate stenting. A case of VA origin symptomatic stenosis successfully treated with stenting using the new pull-through technique from the contralateral brachial artery to the brachial artery on the affected side is described.

Endovascular Angioplasty for Extracranial Vertebral Artery Occlusion Without Visualization of the Stump of the Artery Ostium

“…18) An ipsilateral retrograde brachial arterial approach with a long sheath may also be acceptable if the origin is at an ideal angle to the SCA. 12) However, in our case, the technical success of this technique was uncertain because the angle of VA ostium was not known.…”

“…Previous reports have described Stenting for Proximal VA Occlusion a variety of techniques used to obtain stability of the guide catheter. 6,8,12,15,18,19) The buddy wire technique is a well-known and rapid technique, 8) although this can provide unsatisfactory support for the guide catheter during passage beyond the occlusion. We selected the pull-up technique with a GooseNeck Snare as it provides stable support for the guide catheter and a smooth approach to the lesion.…”

New Pull-through Technique Using the Superficial Temporal Artery for Transbrachial Carotid Artery Stenting -Technical Case Report-

“…Recently, a brachiofemoral or brachiobrachial pull-through approach was described for the treatment of lesions in the innominate, subclavian, or vertebral arteries. 9,10) Here we performed CAS with the pull-through method between the STA and the brachial artery. The STA is easy to expose in the preauricular area using a cut-down technique.…”

“…No hemodynamic events occurred in the forearm despite the use of the guiding catheter with a relatively large diameter. 10) However, use of the smallest guiding system possible will reduce the possibility of complications at the puncture site including insufficient blood flow in the forearm. 4,5,12) In our case, the left brachial artery also revealed some atherosclerotic stenosis, so minimizing the size of the guiding system was important.…”

Brachial Artery Approach for Endovascular Treatment of Posterior Circulation Intracranial Vascular Disease: Technique and Application in 5 Cases

“…In particular, recent published work has focused on the transradial artery approach, and we were able to find only 2 single-patient case reports describing transbrachial artery access for purely therapeutic neuroendovascular procedures. 5,6 To highlight the utility of this technique, we describe 5 cases in which a transbrachial approach was chosen for the endovascular treatment of complicated cerebrovascular disease after treatment via a traditional transfemoral route had failed. All of the cases were performed between July 2005 and June 2007.…”