Aortic arch vessel stenting: A single-center experience using cerebral protection

Hypothesis: Endovascular interventions have revolutionized the contemporary treatment of peripheral vascular occlusive disease. Traditional management of supra-aortic trunk disease has employed surgical extra-anatomic bypass via a cervical approach or median sternotomy. Endoluminal therapy may be a less morbid alternative. Design and Setting: A retrospective review of procedures performed by vascular surgeons in an operating room angiosuite at a single university-based, tertiary referral center. Patients: Eighteen consecutive patients with 20 brachiocephalic-origin stenoses. Interventions: From December 2001 through September 2005, 20 brachiocephalic-origin stenoses were treated endoluminally with balloon-expandable stents. Treated vessels were innominate (n=8), common carotid (n=9), and subclavian (n=3). The target lesion was accessed by one of the following methods: antegrade via the femoral artery (n=5), retrograde through the brachial artery (n=1), or via a retrograde cut-down on the common carotid artery (n=14). Cerebral protection was achieved with either a distal embolic filter device or with open surgical occlusion of the distal common carotid artery. Main Outcome Measures: We report immediate and midterm outcomes of all aortic arch vessel stenting procedures with mean follow-up of 12 months. Results: Mean age was 68 years (6 men and 12 women) and overall mean stenosis was 85%. Preprocedural symptoms including stroke, transient ischemic attack, arm fatigue, digital ischemia, and angina were present in 16 of 20 cases (80%). The 4 asymptomatic patients all had more than 90% stenosis on angiography. At 30-day follow-up, there were no deaths, myocardial infarctions, or strokes. During follow-up, there were no cases of restenosis. Conclusion: Endoluminal arterial stenting of brachiocephalic arch vessels may be a viable alternative to traditional open bypass in cases of focal stenotic disease.