Endovascular Treatment of Innominate Artery Occlusion With Simultaneous Vertebral and Carotid Artery Distal Protection: Case Report
Endovascular Treatment of Innominate Artery Occlusion With Simultaneous Vertebral and Carotid Artery Distal Protection: Case Report
复制标题
DOI：
10.1227/01.neu.0000367549.33541.34
复制
发表时间：
2010-04-01
期刊：
影响因子：
4.8
通讯作者：
Albuquerque, Felipe C.
中科院分区：
文献类型：
--
作者：
Stiefel, Michael F.;Park, Min S.;Albuquerque, Felipe C.
目的：动脉粥样硬化性无名动脉狭窄或阻塞是一种罕见的疾病。传统的外科治疗是一种技术要求很高的干预措施，其发病率和死亡率可以接受，但不能忽略。血管内治疗主动脉上病变已取得成功，现在是头臂血管狭窄的首选治疗方法。脑保护装置在锁骨下和无名动脉介入治疗中的应用较少。临床表现：1例58岁女性，在1998年接受左侧颈总动脉(CCA)支架和右侧无名动脉支架置入术3周后，合并有左侧大脑中动脉卒中病史的大矢状巨细胞性动脉炎。她最近表现出更严重的头晕、共济失调和右臂麻木，并被转到血管内神经外科服务进行治疗。干预：初步血管造影显示左侧颈总动脉狭窄和右侧无名性闭塞。患者最初接受了左侧颈总动脉血管成形术，计划分阶段进行。随后，通过股动脉和右臂动脉入路对右侧无名动脉进行再通术。这种三部位技术可以同时保护右侧颈椎和颈动脉的远端。结论：重新开放长期闭塞的无名动脉有可能导致右侧椎动脉和颈动脉同时出现栓塞雨。利用多个动脉通路，可以在颈椎和颈动脉部署远端保护装置，以降低中风的风险。
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.