KISSING STENT TECHNIQUE IN THE TREATMENT OF INNOMINATE ARTERY STENOSIS

  • Nelson Camacho Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • Anita Quintas Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • Leonor Vasconcelos Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • Frederico Bastos Gonçalves Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • Gonçalo Alves Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • Gonçalo Rodrigues Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • Rodolfo Abreu Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • Rita Ferreira Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • Joana Catarino Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • Maria Emília Ferreira Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • João Albuquerque e Castro Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
  • Luís Mota Capitão Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
Keywords: Endovascular treatment, kissing stent technique, innominate artery

Abstract

Introduction: The presence of symptomatic atherosclerotic stenosis of the innominate artery is an uncommon condition. The authors report the use of kissing stent technique in right subclavian and common carotid arteries with covered stents and cerebral protection by direct clamping of common carotid artery, as a hybrid endovascular alternative to treat symptomatic stenosis of the innominate artery.

Case Report: A 75-year-old male was admitted to Vascular Surgery Department with repeated transient ischemic attacks (TIA’s) of the right cerebral hemisphere, resulting in transitory left hemiparesis. Computerized tomography angiography (CTA) excluded significant carotid lesions and revealed stenosis of the innominate artery associated with mural thrombus that extended to the bifurcation. 
The right common carotid artery and axillary artery were surgically exposed. Brain protection was achieved by direct clamping of the common carotid artery and subsequently carotid and axillary retrograde endovascular access was obtained. Two balloon-expandable covered stents were placed in the innominate, subclavian and right common carotid arteries, using the kissing stent technique. At the end of the procedure, a good permeability of the revascularized arteries was verified and a direct expulsion of eventual embolic material was performed prior to declamping. The postoperative period was uneventful.

Conclusion: The kissing stent technique, with covered stents, in innominate, right subclavian and common carotid arteries with direct protection of the common carotid by clamping is a possible and minimally invasive solution for the treatment of symptomatic stenosis of the innominate artery.

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References

1. Christopoulos DC, Kardamis C, Pitoulias GA, et al. Simultaneous
transcervical angioplasty and stenting of innominate and right
internal carotid arteries. Ann Vasc Surg. 2014; 492.e11–5.
2. Yamamoto M, Hara H, Shinji H, et al. Endovascular treatment of
innominate artery stenosis via the bilateral brachial approach.
Cardiovasc Revasc Med 2010;11(2):105–9.
3. Hadjipetrou P, Cox S, Piemonte T, Eisenhauer A. Percutaneous
revascularization of atherosclerotic obstruction of aortic arch
vessels. J Am Coll Cardiol. 1999; 33(5):1238–45.
4. Eisenhauer AC. Subclavian and innominate revascularization:
surgical therapy versus catheter-based intervention. Curr Interv
Cardiol Rep 2000;2:101–10.
5. Brountzos EN, Malagari K, Kelekis DA. Endovascular treatment
of occlusive lesions of the subclavian and innominate arteries.
Cardiovasc Intervent Radiol 2006;29:503–10.
6. Paukovits TM, Lukács L, Bérczi V, et al. Percutaneous endovascular
treatment of innominate artery lesions: a single-centre experience
on 77 lesions. Eur J Vasc Endovasc Surg. 2010;40(1):35–43.
Published
2017-09-30
Section
Clinical Case