[Percutaneous transluminal angioplasty for multiple brachiocephalic artery stenosis: case report]

We encountered a patient with multiple stenotic lesions. He was treated by percutaneous transluminal angioplasty (PTA). The patient, a 59 year-old male, complained of right motor weakness. CT scan showed a multiple low density area (LDA) in the distribution of the right middle cerebral artery (MCA), but did not reveal LDA in the distribution of the left MCA on the affected side. After hospitalization, right motor weakness gradually worsened and aphasia became apparent. A repeat CT scan, 8 days after the stroke, disclosed a new LDA in the left watershed zone and the basal ganglia. Angiographical findings revealed a right ICA occlusion, left ICA stenosis, right VA anaplasia and left subclavian artery stenosis, which proved inadequate for anatomical collateral supply. We treated both the left ICA stenosis and the left subclavian artery stenosis by Dotter balloon dilatation catheter, and successfully obtained sufficient dilatation of the vessels concerned. No complication occurred. PTA is a useful method to use in patients with multiple stenotic lesions which might result in ischemic injury if surgical procedures were used. It would also be of value in cases where surgery using general anesthesia might be highly risky.