Percutaneous Endovascular Treatment of Innominate Artery Lesions: A Single-centre Experience on 77 Lesions

Paukovits, Tamás Mirkó; Lukács, L.; Bérczi, Viktor; Hirschberg, Kristóf; Nemes, Balázs; Hüttl, Kálmán

doi:10.1016/j.ejvs.2010.03.017

Cited by 53 publications

(25 citation statements)

References 31 publications

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“…Asymptomatic patients or patients with a wide array of symptoms such as arm ischemia, stroke, or myocardial ischemia were included. [7][8][9] Neurologic outcomes were not studied in detail.…”

Section: Oy-stermentioning

confidence: 99%

Pearls & Oy-sters: Symptomatic innominate artery disease

Guedes¹,

Valeriano

Puglia

et al. 2016

Neurology

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Section: Oy-stermentioning

confidence: 99%

Pearls & Oy-sters: Symptomatic innominate artery disease

Guedes¹,

Valeriano

Puglia

et al. 2016

Neurology

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“…It may present with the symptoms of ischemic disease of the right arm and brain, usually posterior circulation. The most common source IAS derived emboli is a local plaque rupture and, less frequently, dissection, thrombosis due to mechanical effects, radiation, hypercoagulation and mural thrombus of ascending aorta [4][5][6][7][8][9][10][11]. MCA occlusion from IAS, as in our case, is the most likely pathophysiology given the intra-operative finding of fresh thrombotic material in the innominate artery.…”

Section: Discussionmentioning

confidence: 97%

“…The most common cause of IA disease is atherosclerosis followed by Takayasu's arteritis, dissection, thoracic outlet syndrome, radiotherapy-induced supra-aortic stem disease, mural thrombus of ascending aorta, nephrotic syndrome and fibromuscular dysplasia. High-grade IA stenosis (IAS) or occlusion can cause inherent dynamic changes in cerebral blood flow with flow reverseal in both, the vertebral and carotid arteries and is sometime called double subclaviancarotid steal syndrome, or the innominate steal syndrome [3][4][5][6][7][8][9][10][11][12][13]. While symptoms are often transient due to the hemodynamic nature diagnosis can be made using noninvasive methods such as Doppler ultrasound, angiographic examinations and bilateral blood pressure measurements.…”

Section: Introductionmentioning

confidence: 99%

Embolic Middle Cerebral Artery Occlusion from Innominate Artery Stenosis: Successful Mechanical Recanalisation

Taroza¹,

Valaikienė

Schlachetzki³

et al. 2016

J Neurol Neurosci

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Embolic complications resulting from significant innominate artery stenosis (IAS) is a rare pathology. We present a clinical case of IAS with subsequent middle cerebral artery (MCA) occlusion detected with cerebral computed tomography and neurovascular ultrasound and successfully treated using endovascular embolectomy within 4 hours after symptom onset. The patient recovered well. Additional IAS endarterectomy days later showed fresh thrombi on the vessel wall, and resulted in complete normalisation of cerebral blood flow. This is to the best of our knowledge the first case of MCA embolectomy from an emboligenic IAS. Although not used in the successful embolectomy trials in the last years, neurosonography was crucial to guide the revascularisation therapy and the hemodynamic compromise in IAS might have led to ischemic preconditioning and thus better outcome upon revascularisation. Endovascular embolectomy in patients with IAS and MCA occlusion must not necessarily need stent angioplasty of the IAS in the acute stroke phase thus avoiding double platelet therapy upon cerebral reperfusion.Given the rareness of the disease, an international registry of similar cases may help to better understand the disease and guide acute interventions.

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“…16,17) Various protection methods have been reported. These include dual protection from the brachial side (as was employed in this case); dual protection from the femoral side; no protection of VA based on the prediction that antegrade blood flow in the VA will not reestablish for some time following resolution of innominate artery stenosis when subclavian steal was apparent preoperatively; and a distal retrograde approach by entering the CCA with surgical exposure and direct clamping of the CCA.…”

Section: Discussionmentioning

confidence: 99%

Direct Puncture of a Surgically-exposed Femoral Artery Graft for Simultaneous Stenting of Coronary, Carotid and Innominate Artery Stenoses

Matsuo

Fujita

Tanaka

et al. 2017

JNET

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Objective: The number of access routes for endovascular treatment is limited in patients with a history of aorto-femoral bypass surgery. Here, we present a patient with stenosis of the coronary, left carotid, and innominate arteries. We performed simultaneous stenting of each stenotic lesion by direct puncture of a femoral artery graft with surgical exposure and purse string suture ligation. Case Presentation:The patient was a 74-year-old male with a history of aorto-bifemoral bypass surgery, coronary artery stenting, and coronary artery bypass grafting for systemic atherosclerotic disease. Coronary artery stenting became necessary because of recurring angina pectoris. The three lesions were treated simultaneously by surgical exposure and direct graft puncture and 9 Fr sheath insertion. The punctured graft was sutured for hemostasis. No puncture site complications were noted. Conclusion:This case suggests that when the number of possible access routes for endovascular treatment is limited, it is feasible and safe to perform direct graft puncture with surgical exposure, and to achieve hemostasis by suturing the puncture site.

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Percutaneous Endovascular Treatment of Innominate Artery Lesions: A Single-centre Experience on 77 Lesions

Abstract: Transfemoral PTA with or without stent appears to be a safe treatment option for innominate artery lesions.

Cited by 53 publications

References 31 publications

Pearls & Oy-sters: Symptomatic innominate artery disease

Pearls & Oy-sters: Symptomatic innominate artery disease

Embolic Middle Cerebral Artery Occlusion from Innominate Artery Stenosis: Successful Mechanical Recanalisation

Direct Puncture of a Surgically-exposed Femoral Artery Graft for Simultaneous Stenting of Coronary, Carotid and Innominate Artery Stenoses

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