Two Cases of Innominate Artery Stenting via Alternative Upper-Extremity Arterial Access Using Tailored Distal...

Percutaneous transluminal angioplasty and stenting (PTAS) have been reported as a useful endovascular intervention for innominate artery stenosis (IAS); however, reports of treatment completed exclusively via an upper-extremity approach are limited. Here, we report 2 cases of IAS in which transfemoral access was not feasible and were successfully treated with PTAS via upper-extremity access.

Case 1-A 74-year-old woman was admitted with a cerebral infarction due to left carotid artery stenosis. Severe stenosis at the origin of the innominate artery caused right hemisphere hypoperfusion. Transfemoral access was at high risk owing to an abdominal aortic aneurysm. PTAS for IAS was performed via brachial access using a sheathless balloon-guiding catheter positioned distal to the lesion. Temporary balloon occlusion resulted in distal flow arrest for cerebral protection. No new ischemic lesions were observed postoperatively. Case 2-An 80-year-old woman presented with left-sided weakness and a history of surgical angioplasty for bilateral femoral artery occlusion. Diffuse plaques in the innominate arteries caused embolic cerebral infarctions that were refractory to medical therapy. The right vertebral artery was occluded or hypoplastic. Distal protection of the right internal carotid artery was achieved using a filter device via the radial approach, followed by PTAS via the brachial approach. No postoperative cerebral infarction was observed.

PTAS with distal embolic protection via upper-extremity access has achieved favorable outcomes. Distal embolic protection strategies should be individualized for each IAS case.