Outcomes of Innominate Artery Revascularization Through Endovascular, Hybrid, or Open Approach

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Cerebrovascular Disease

Background:

• Innominate artery (IA) atherosclerosis is rare but can cause significant neurological and upper extremity symptoms.
• Endovascular interventions, often combined with carotid procedures, are used for non-occlusive IA lesions.
• Calcified IA lesions pose a high risk of embolization, while occlusive lesions may require bypass surgery.

Purpose of the Study:

• To review short-term and long-term outcomes of innominate artery (IA) revascularization.
• To evaluate the safety and efficacy of hybrid and open surgical approaches for IA disease.
• To assess neurological events, mortality, and reintervention rates following IA revascularization.

Main Methods:

• Retrospective review of patients undergoing IA revascularization (1998-2018).
• Included patients undergoing innominate artery stenting (IAS), combined procedures (RCEA + IAS), and aortoinnominate bypass (AIB).
• Primary endpoints: freedom from neurologic events, all-cause mortality, and need for reintervention.

Main Results:

• Thirty-three patients underwent IA revascularization; 64% were symptomatic.
• Perioperative stroke rate was 3%, with 0% perioperative mortality.
• Long-term outcomes included 0% stroke, 15% mortality (cardiac), and 9% restenosis requiring intervention.

Conclusions:

• IA revascularization using hybrid or open approaches is safe with acceptable perioperative and long-term results.
• Bilateral cerebral embolic protection strategies are effective.
• Innominate artery stenting may have higher restenosis rates than bypass, recommending vigilant follow-up.