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Bilateral brachial pull-through technique for stenting in a patient with stenosis of the vertebral artery origin:
N Kusaka1, T Tamiya, M Nishiguchi
1Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, 2-5-1 Kuroiso-cho, Iwakuni, Yamaguchi 740-8510, Japan. kusaka@iwakuni-nh.go.jp
Insights
A new technique allows successful stenting for vertebral artery stenosis when standard femoral access is impossible. This contralateral brachial pull-through approach offers an alternative for complex cases.
Area of Science:
- Interventional neuroradiology
- Vascular surgery
- Medical device technology
Background:
- Proximal vertebral artery (VA) stenosis is often treated with stenting via a transfemoral approach.
- Iliofemoral occlusive disease can preclude safe femoral access for these procedures.
Observation:
- A case is presented where both transfemoral and ipsilateral brachial access were challenging due to patient-specific vascular conditions.
- A novel brachiobrachial pull-through technique from the contralateral brachial artery was employed.
Findings:
- The brachiobrachial pull-through technique enabled efficient and accurate stenting of the symptomatic proximal VA stenosis.
- This approach successfully navigated challenging vascular anatomy where standard methods failed.
Implications:
- This technique provides a viable alternative for treating VA stenosis in patients with complex iliofemoral or brachial vascular disease.
- It expands interventional options for managing cerebrovascular disease, improving patient outcomes.
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.
