TY - JOUR
T1 - Endovascular recanalization of the chronically occluded brachiocephalic and subclavian arteries
T2 - Technical considerations and an argument for embolic protection
AU - Albuquerque, Felipe C.
AU - Ahmed, Azam
AU - Mitha, Alim
AU - Stiefel, Michael
AU - McDougall, Cameron G.
PY - 2013/12
Y1 - 2013/12
N2 - Objective: We described our endovascular techniques for the recanalization of chronic occlusions of the brachiocephalic and subclavian arteries. Given their large caliber, origins from the aorta, and proximity to the carotid and vertebral arteries, various complex endovascular techniques are required to achieve revascularization. Navigation of distal embolic protection devices into the carotid and vertebral arteries mandates varied catheter approaches. Methods: Four women harboring chronic occlusions of the brachiocephalic and subclavian arteries were evaluated for their presenting symptoms, neurologic status, endovascular treatment, complications, and radiographic and clinical follow-up. We reviewed three specific treatment scenarios and analyzed predictive factors associated with treatment failure. Results: Three chronic occlusions of the subclavian artery and 1 chronic occlusion of the brachiocephalic artery were identified in the four patients. All patients previously had experienced a stroke in the affected vascular territory or transient ischemic attacks from steal syndromes. Three target vessels were reopened successfully with angioplasty and stenting. In all cases, distal embolic protection devices were used, and multiple access points, including radial, brachial, and femoral catheterization, were required. Angiographic follow-up (range, 6-18 months) demonstrated stable patency of the stents in the three successfully treated patients. There were no transient or permanent complications. Conclusions: Endovascular recanalization of the great vessels with the use of distal embolic protection devices requires multiple catheters and complex endovascular techniques but is feasible and safe. A significant percentage of these occlusions can likely be reopened through endovascular techniques.
AB - Objective: We described our endovascular techniques for the recanalization of chronic occlusions of the brachiocephalic and subclavian arteries. Given their large caliber, origins from the aorta, and proximity to the carotid and vertebral arteries, various complex endovascular techniques are required to achieve revascularization. Navigation of distal embolic protection devices into the carotid and vertebral arteries mandates varied catheter approaches. Methods: Four women harboring chronic occlusions of the brachiocephalic and subclavian arteries were evaluated for their presenting symptoms, neurologic status, endovascular treatment, complications, and radiographic and clinical follow-up. We reviewed three specific treatment scenarios and analyzed predictive factors associated with treatment failure. Results: Three chronic occlusions of the subclavian artery and 1 chronic occlusion of the brachiocephalic artery were identified in the four patients. All patients previously had experienced a stroke in the affected vascular territory or transient ischemic attacks from steal syndromes. Three target vessels were reopened successfully with angioplasty and stenting. In all cases, distal embolic protection devices were used, and multiple access points, including radial, brachial, and femoral catheterization, were required. Angiographic follow-up (range, 6-18 months) demonstrated stable patency of the stents in the three successfully treated patients. There were no transient or permanent complications. Conclusions: Endovascular recanalization of the great vessels with the use of distal embolic protection devices requires multiple catheters and complex endovascular techniques but is feasible and safe. A significant percentage of these occlusions can likely be reopened through endovascular techniques.
KW - Brachiocephalic
KW - Chronic
KW - Embolic protection
KW - Endovascular
KW - Occlusion
KW - Revascularization
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U2 - 10.1016/j.wneu.2012.04.031
DO - 10.1016/j.wneu.2012.04.031
M3 - Review article
C2 - 23043999
AN - SCOPUS:84889681646
SN - 1878-8750
VL - 80
SP - e327-e336
JO - World neurosurgery
JF - World neurosurgery
IS - 6
ER -