Pearls & Oy-sters: Symptomatic innominate artery disease

Inversão total do fluxo em artéria carótida interna direita em paciente com estenose grave do tronco braquiocefálico

“…The most common USD finding in lesions involving the BCT is flow reversal in the right vertebral artery (subclavian steal phenomenon) 14 ; but, in contrast with "single" subclavian steal, which occurs in obstructive lesions of the subclavian artery, there are also changes to flow in the right carotid system. 1,15,16 Manifestations can range from reduction of peak systolic velocity in the carotid artery, with flow remaining anterograde, to cases of total reversal of flow, as reported in the present case. A hypothesis of a significant obstructive lesion of the BCT should always be considered in cases in which there is diffuse reduction of flow in the right carotid artery.…”

“…Severe stenoses and occlusions of the BCT are rare conditions and their true prevalence may well be unknown. 1 In a study analyzing 30,000 USD examinations, the prevalence of obstructive disease involving the BCT was lower than 0.1%, 12 while angiography studies suggest that they account for around 2.5% of lesions involving the extracranial circulation. 12 The most common cause is atherosclerosis, while other possible etiologies include Takayasu's Arteritis, giant-cell arteritis, radiotherapy-induced actinic fibrosis, and fibromuscular dysplasia.…”

“…Six of these describe hypoflow through the internal carotid artery without flow reversal in any phase of the cardiac cycle, 12,13,15,19,22,23 and three only referred to the common carotid, without describing findings specific to the internal carotid. 1,14,17 The most often reported finding (in 13 articles) was partial reversal of flow in the internal carotid artery, with retrograde flow during systole, but antegrade flow in diastole. 2,3,[5][6][7][8][9][10]16,18,20,21,24 Just two studies described complete reversal of flow in the internal carotid throughout the entire cardiac cycle: Grant et al 11 observed reversal with minimal diastolic flow and Borne et al 4 observed reverse flow throughout the whole cardiac cycle, but with systolic velocity of 37 cm/s.…”

“…Ackerstaff et al 17 1984 Only mentions the common carotid Borne et al 4 2015 Total reversal Brunhölzl and von Reutern 12 1989 Hypoflow without reversal Calin et al 18 2018 Partial reversal Deurdulian et al 2 2016 Partial reversal Esen et al 5 2016 Partial reversal Filis et al 6 2008 Partial reversal Grant et al 11 2006 Total reversal Grosveld et al 14 1988 Only mentions the common carotid Guedes et al 1 2016 Only mentions the common carotid Han et al 7 2017 Partial reversal Horrow et al 19 2008 Hypoflow without reversal Maier et al 20 2014 Partial reversal Racy 10 2019 Partial reversal Rawal et al 13 2019 Hypoflow without reversal Rodriguez 3 2016 Partial reversal Schwend et al 21 1995 Partial reversal Scoutt 15 2019 Hypoflow without reversal Sidhu e Morarji 22 1995 Hypoflow without reversal Tenny and Fleischmann 9 2017 Partial reversal Verlato et al 23 1993 Hypoflow without reversal Uzun et al 8 2008 Partial reversal Willoughby et al 16 2014 Partial reversal Zwiebel and Pellerito 24 2005 Partial reversal…”

“…Stenoses or occlusions of the brachiocephalic trunk (BCT, innominate artery) are rare and can present with a variety of clinical signs. [1][2][3] Since the right subclavian artery and the right common carotid artery originate from the BCT, there may be manifestations of right upper limb ischemia, vertebrobasilar ischemia due to subclavian steal, or hemispheric symptoms related to carotid flow. 2,4 Supplementary findings seen on vascular Doppler ultrasonography (USD) are highly variable.…”