Percutaneous and open retrograde endovascular stenting of symptomatic high-grade innominate artery stenosis: technique and follow-up.

Abstract

BACKGROUND AND PURPOSE:

Angioplasty and stenting of the IA have been reported with high technical and clinical success rates, low complication rates and good mid-term patency rates. Different antegrade or retrograde endovascular catheter-based approaches and combinations with surgical exposure of the CCA are used. The purpose of this study was to determine safety, efficacy and mid-term clinical and radiological outcome of the stent-assisted treatment of atherosclerotic stenotic disease of the IA with special focus on the different technical approaches.

MATERIALS AND METHODS:

Between 1996 and 2008, 18 patients (12 men, 6 women) with symptomatic high-grade stenosis (>80%) of the IA were treated with endovascular stent placement. Their mean age was 60.4 years (range, 48-78 years). Mean angiographic and clinical follow-up was 2.7 years (range, 0.3-9.1 years). Clinical follow-up was performed by using the mRS at hospital discharge, routine follow-up controls, and a questionnaire. In 11 patients, a percutaneous approach was used. In 7 patients, the lesions were accessed retrogradely through a cervical cut-down with common carotid arteriotomy. In 2 patients, a simultaneous ipsilateral carotid endarterectomy was performed.

RESULTS:

In all patients, primary stent placement was performed. There were 2 procedure-related transient complications (11.1%) due to cerebral embolism without permanent morbidity or mortality. During the follow-up, all patients showed improvement of the preprocedural symptoms. At the latest clinical follow-up (mean, 2.7 years), all patients showed an excellent or good outcome (mRS, 0 or 1). In 2 patients (11.1%), a secondary stent placement was needed due to a significant symptomatic in-stent stenosis.

CONCLUSIONS:

Percutaneous and open retrograde stenting of high-grade stenosis of the IA is a viable less invasive alternatives to open bypass surgery with good midterm clinical results and patency rates.

• Authors: P Mordasini, J Gralla, D-D Do, J Schmidli, B Keserü, M Arnold, U Fischer, G Schroth, C Brekenfeld
• Journal: AJNR. American journal of neuroradiology (AJNR Am J Neuroradiol) Vol. 32 Issue 9 Pg. 1726-31 (Oct 2011) ISSN: 1936-959X [Electronic] United States
• PMID: 21852376 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Angioplasty (methods)
• Brachiocephalic Trunk (pathology)
• Cerebrovascular Circulation
• Endovascular Procedures (methods)
• Female
• Follow-Up Studies
• Humans
• Intracranial Arteriosclerosis (pathology, therapy)
• Magnetic Resonance Angiography
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Postoperative Complications
• Stents
• Treatment Outcome