Simultaneous Kissing Stenting: A Valuable Technique for Reconstructing the Stenotic Initial Segment of the Right Subclavian Artery

Atherosclerotic stenosis or occlusion often involves the subclavian artery. For lesions that are close to the orifice of the right subclavian artery, stenting of the right subclavian artery itself blocks the pathway from the innominate artery to the right carotid artery and causes problems in patients with multiple angiostenosis, especially involving the right carotid system. In this study, we report 2 cases using simultaneous kissing stenting (SKS) of the right subclavian artery and the right carotid artery to relieve right subclavian stenosis and maintain right carotid system patency. Standard stenting methods were used to perform SKS. Two self-expanding stents were implanted simultaneously into the initial segment of the right subclavian artery and the right carotid artery, forming a “Y” shape, with the overlap of the proximal segments in the innominate artery ≥5 mm. After SKS, the stenosed right subclavian artery was dilated, and the patency of the right carotid system was maintained. The symptoms of patients were relieved and the stents were intact at several months of follow-up. In conclusion, SKS of the right subclavian artery and the right carotid artery might be a safe and effective procedure when the stenotic or occlusive lesion in the initial segment of the right subclavian artery is close to the orifice, and lesions (or potential ones) exist in the right carotid system.

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Endovascular Treatment of Innominate Artery Occlusion With Simultaneous Vertebral and Carotid Artery Distal Protection

Neurosurgery ◽

10.1227/01.neu.0000367549.33541.34 ◽

2010 ◽

Vol 66 (4) ◽

pp. E843-E844 ◽

Cited By ~ 16

Author(s):

Michael F. Stiefel ◽

Min S. Park ◽

Cameron G. McDougall ◽

Felipe C. Albuquerque

Keyword(s):

Carotid Artery ◽

Carotid Arteries ◽

Innominate Artery ◽

Artery Occlusion ◽

Left Middle Cerebral Artery ◽

Arterial Access ◽

Atherosclerotic Stenosis ◽

Protection Devices ◽

Distal Protection ◽

The Right

Abstract OBJECTIVE Atherosclerotic stenosis or obstruction of the innominate artery is rare. Traditional surgical management is a technically demanding intervention with acceptable, but not negligible, rates of morbidity and mortality. Endovascular approaches to supraaortic lesions have been successful and are now the preferred treatment for stenoses of the brachiocephalic vessels. The use of cerebral protection devices in subclavian and innominate interventions is less established. CLINICAL PRESENTATION A 58-year-old woman had Takayasu giant cell arteritis with a history of a left middle cerebral artery stroke 3 weeks after undergoing placement of a left common carotid artery (CCA) stent and right innominate artery stent in 1998. She recently presented with worsening dizziness, ataxia, and right arm numbness and was referred to the endovascular neurosurgery service for management. INTERVENTION Initial angiography revealed left CCA stenosis and right innominate occlusion. The patient initially underwent left CCA angioplasty, planned as a staged procedure. This was followed by recanalization of the right innominate artery through an approach using both femoral arteries and the right brachial artery. This 3-site technique allowed simultaneous distal protection of both the right cervical vertebral and carotid arteries. CONCLUSION Reopening a chronically occluded innominate artery risks an embolic shower through both the right vertebral and carotid arteries. Using multiple sites of arterial access, distal protection devices can be deployed in both the cervical vertebral and carotid arteries to reduce the risk of stroke.

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Anatomical Predictors of Left Internal Carotid Artery Catheterization in Transradial Angiography

10.1101/2021.10.07.21264684 ◽

2021 ◽

Author(s):

Seon Woong Choi ◽

Hoon Kim ◽

Seong Rim Kim ◽

Ik Seong Park ◽

Sunghan Kim

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Internal Carotid ◽

Multivariable Analysis ◽

Innominate Artery ◽

Left Internal Carotid Artery ◽

Arch Height ◽

Contrast Enhanced

ABSTRACTIntroductionTransradial angiography (TRA) has received considerable attention in the field of neurointervention owing to its advantages over transfemoral approaches. However, the difficulty of left internal carotid artery (ICA) catheterization under certain anatomical conditions of the aortic arch and its branches is a limitation of TRA. This study aimed to investigate the anatomical predictors of successful catheterization of the left ICA in TRA.Materials and MethodsFrom January 2020 to October 2020, 640 patients underwent TRA at a single institute. Among them, 263 consecutive patients who were evaluated by contrast-enhanced MRI before TRA were included in our study and assigned to success and failure groups, according to whether left ICA catheterization was possible or not. Anatomical predictors that may affect the success of left ICA catheterization in TRA were investigated for the purposes of our study.ResultsThe multivariable analysis included variables that demonstrated significant univariate associations with ICA catherization (P<0.0001). Variables included in the model were the type of aortic arch, height of right subclavian artery, turn-off angle of the left common carotid artery (CCA), distance between innominate artery to the left CCA, angulation of right subclavian artery, and angulation of the left CCA, which we identified as significant predictors of left ICA catheterization.ConclusionSuccess of left ICA catheterization in TRA was related to the vascular geometry of the aortic arch and its branches. Evaluating the anatomical predictors identified in this study using pre-procedure imaging may enhance the success rate of left ICA catheterization in TRA.

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An unusual origin of the right subclavian artery – arteria lusoria

Current Issues in Pharmacy and Medical Sciences ◽

10.1515/cipms-2015-0022 ◽

2014 ◽

Vol 27 (4) ◽

pp. 234-236

Author(s):

Agnieszka Mocarska ◽

Miroslaw Szylejko ◽

Elzbieta Staroslawska ◽

Franciszek Burdan

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Common Carotid Artery ◽

Left Vertebral Artery ◽

Anatomical Anomaly ◽

Arteria Lusoria ◽

Brachiocephalic Trunk ◽

The Right

Abstract The aortic arch usually gives off three major arterial branches: the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. The most frequently occurring developmental variations of arterial trunks origins are a joined brachiocephalic and left common carotid artery origin, the left vertebral artery branching from the aortic arch, a double aortic arch, and a change of sequence of branching arteries. The current report presents the rare asymptomatic situation of the right subclavian artery originating as the last individual branching from the aortic arch. This abnormality was accidentally discovered in a computed tomography examination of a 69-year old male patient. The examination showed that the artery went towards the neck posteriorly from the trachea. The anatomical anomaly was interpreted as being an arteria lusoria.

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Percutaneous or Side-Arm Graft Right Subclavian Artery Cannulation via Median Sternotomy

Aorta ◽

10.1055/s-0039-3401019 ◽

2019 ◽

Vol 07 (05) ◽

pp. 150-153

Author(s):

Corrado Cavozza ◽

Antonio Campanella ◽

Pellegrino Pasquale ◽

Andrea Audo

Keyword(s):

Cardiopulmonary Bypass ◽

Subclavian Artery ◽

Circulatory Arrest ◽

Median Sternotomy ◽

Innominate Artery ◽

Bypass Flow ◽

Surgical Incision ◽

Artery Cannulation ◽

The Right ◽

Antegrade Cerebral Perfusion

AbstractSeveral cannulation sites alternative to the ascending aorta, such as femoral, right axillary, carotid, innominate artery, and, less commonly, apical sites, have been proposed. Cannulation of the right subclavian artery, through sternotomy, is one possible means of establishing cardiopulmonary bypass, hence avoiding a second surgical incision. In our experience, cardiopulmonary bypass flow was adequate and circulatory arrest with antegrade cerebral perfusion was successfully performed in all cases. There was no in-hospital mortality.

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A rare anomalous origin of right vertebral artery with double branch: First case report

Interventional Neuroradiology ◽

10.1177/1591019917733126 ◽

2017 ◽

Vol 24 (2) ◽

pp. 225-228 ◽

Cited By ~ 2

Author(s):

Ya-dong Liu ◽

Zhi-qiang Li ◽

Jing-jing Fu ◽

Ya-jun E

Keyword(s):

Case Report ◽

Carotid Artery ◽

Vertebral Artery ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Incidental Findings ◽

Aberrant Right Subclavian Artery ◽

First Case ◽

The Right ◽

Double Origin

Vertebral artery origin anomalies are typically incidental findings during angiography. We present an extremely rare variant in which the right vertebral artery has a double origin from the right subclavian artery and right common carotid artery in association with an aberrant right subclavian artery, which has never been reported before.

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The carotid arterial approach for balloon dilation of critical aortic stenosis in neonates—immediate results and follow-up

Cardiology in the Young ◽

10.1017/s1047951100011732 ◽

1995 ◽

Vol 5 (2) ◽

pp. 155-160 ◽

Cited By ~ 10

Author(s):

Sandra Giusti ◽

Adele Borghi ◽

Sofia Redaelli ◽

Philipp Bonhoeffer ◽

Isabella Spadoni ◽

...

Keyword(s):

Carotid Artery ◽

Aortic Stenosis ◽

Aortic Regurgitation ◽

Balloon Dilation ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Critical Aortic Stenosis ◽

The Right

SummaryBalloon dilation of the aortic valve was performed in 20 consecutive neonates with critical aortic stenosis using an approach achieved by cutting down on the right carotid artery. The age of the patients ranged from one to 25 days (mean seven days) and their weight from 2.1 to 4.0 kg (mean 3.16 kg). All patients were evaluated before cardiac catheterization with cross-sectional and Doppler echocardiography so as to keep the catheterization procedure as short as possible. Balloon dilation was accomplished in all patients. The only complication was an apical perforation by the guide wire in two cases. The ensuing pericardial effusion was immediately drained with pericardiocentesis and the subsequent course of the procedure was uneventful. Immediate results showed dramatic improvement in cardiovascular conditions. The transvalvar pressure gradient fell from 80±40 to 27±20 mm Hg (p<0.001). Left ventricular ejection fraction evaluated by echocardiography increased from 30±21% before dilation to 54±18% 24-48 hours after the procedure (p<0.001). In all patients, the procedure was free from vascular complications. Aortic regurgitation was documented after the procedure in 11 patients, being severe in one, moderate in five and trivial in five. Seven patients died, although in only one was the death related directly to the procedure itself. Six patients died because of associated lesions despite an immediate satisfactory result of the balloon valvoplasty. The 13 surviving patients are doing well, and are receiving no medications. During a mean follow-up of 25 months (range 2-54 months), four patients have developed restenosis. One underwent surgical valvotomy at one year of age. The second was successfully redilated through the same approach at two months of age. The other two have a significant gradient, as assessed by Doppler measurements (60 and 70 mm Hg), with normal systolic ventricular function. Two patients have moderate aortic regurgitation. Balloon dilation achieved through cutdown on the right carotid artery is a safe and effective alternative to surgery in neonates with isolated aortic stenosis. The unfavorable results are mainly due to associated anomalies.

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A Five-Vessel Aortic Arch with an Anomalous Origin of Both Vertebral Arteries and an Aberrant Right Subclavian Artery

Interventional Neuroradiology ◽

10.1177/159101990401000404 ◽

2004 ◽

Vol 10 (4) ◽

pp. 309-314 ◽

Cited By ~ 9

Author(s):

P.A. Brouwer ◽

M.P.S. Souza ◽

R. Agid ◽

K.G. terBrugge

Keyword(s):

Carotid Artery ◽

Vertebral Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Anomalous Origin ◽

Aberrant Right Subclavian Artery ◽

Left Vertebral Artery ◽

Transverse Foramen ◽

The Right

In this case presentation we describe a patient with an anomalous origin of the right vertebral artery arising from the right common carotid artery in combination with an aberrant right subclavian artery and a left vertebral artery originating from the arch between the left common carotid artery and left subclavian artery. Hence there were five vessels originating from the aortic arch. The possible embryological mechanism as well as a postulation on the importance of the level of entrance of the vertebral artery in the cervical transverse foramen is discussed.

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Cervical Origin of the Right Subclavian Artery with a Nonbifurcating Left Cervical Carotid Artery

Interventional Neurology ◽

10.1159/000489019 ◽

2018 ◽

Vol 7 (6) ◽

pp. 399-402

Author(s):

Mohamad Ezzeldin ◽

Eslam W. Youssef ◽

Vibhav Bansal ◽

Ali Sultan Qurraie ◽

Osama Zaidat

Keyword(s):

Carotid Artery ◽

Subclavian Artery ◽

The Right

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Morphometry of the aortic arch and its branches

ARS Medica Tomitana ◽

10.2478/arsm-2013-0027 ◽

2013 ◽

Vol 19 (3) ◽

pp. 154-159 ◽

Cited By ~ 1

Author(s):

A.M. Manole ◽

D.M. Iliescu ◽

A. Rusali ◽

P. Bordei

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Ascending Aorta ◽

Ct Scanner ◽

Arterial Trunk ◽

Brachiocephalic Trunk ◽

The Right

Abstract Our study was conducted by the evaluation of angioCT’s performed on a GE LightSpeed VCT64 Slice CT Scanner. The measurements were performed on the aortic arch at the following levels: at the origin of the aorta, the middle part of the ascending aorta, prior to the origin of the brachiocephalic arterial trunk and after the origin of the left subclavian artery. We measured the caliber of the aortic arch arteries and the data are correlated and reported by gender. The diameter of the ascending aorta was between 27 to 28.9 mm in females and in males from 25.8 to 37.6 mm. The diameter of the aorta within the middle segment of the ascending part was between 28-30.2 mm in females and in males from 26.1 to 34.6. The diameter of the aortic arch prior to the origin of the brachiocephalic arterial trunk was between 26.4 to 29.4 mm in females and in males from 25.8 to 37.5 mm. The diameter of the aortic arch after the origin of the left subclavian artery was in a range of 20.4 to 28.4 mm, which corresponds to the limits found in males while in females the aortic diameter was between 21.3 to 24.1 mm. The brachiocephalic trunk diameters were 8.3 to 15.5 mm in females and in males was 9.1 to 14.5 mm. The right common carotid artery had a diameter of 4-8 mm diameter in males and in females ranged from 4.7 to 5.5 mm. The right subclavian artery showed a caliber of 5.7 to 7.5 mm in females and in males from 5.9 to 10.1. The left common carotid artery diameter was 4.6 to 5.7 mm in females and males the diameter was between 5.2 to 7.4 mm. The left subclavian artery had a diameter of 6-10 mm in females and in males ranged from 7.7 to 12.8 mm. We found that the distance between the ascending part of the aorta and the descending segment ranged from 33.3 to 38.5 mm in females and in males from 40 to 68.6 mm. We measured the distance that exists at the crossing of the aortic arch with the left branch of the pulmonary trunk, finding that in females this distance is 3 to 10.3 mm and in males from 3 to 12.5 mm.

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Carotid–carotid crossover bypass after mechanical thrombectomy for internal carotid artery occlusion due to plaque from stenosed innominate artery

Surgical Neurology International ◽

10.25259/sni_749_2021 ◽

2021 ◽

Vol 12 ◽

pp. 480

Author(s):

Tomoaki Murakami ◽

Shingo Toyota ◽

Takuya Suematsu ◽

Yuki Wada ◽

Takeshi Shimizu ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Mechanical Thrombectomy ◽

Innominate Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Crossover Bypass ◽

The Right ◽

Innominate Artery Stenosis

Background: The treatment for internal carotid artery occlusion (ICAO) due to innominate artery stenosis is not well established. We herein describe a case of carotid–carotid crossover bypass and common carotid artery (CCA) ligation after mechanical thrombectomy for ICAO due to a plaque from the stenosed innominate artery. Case Description: A 70-year-old man was transferred to our hospital because of left-sided hemiparalysis. Head magnetic resonance imaging/angiography showed a cerebral infarction in the right middle cerebral artery area and the right ICAO due to a plaque from the stenosed innominate artery. Immediately, we performed mechanical thrombectomy and successfully attained partial revascularization (Thrombolysis in Cerebral Infarction Grade 2B). After a conference with cardiovascular group, we performed carotid–carotid crossover bypass and the right CCA ligation. The treatment was successful, and no complications occurred. Conclusion: Carotid–carotid crossover bypass and CCA ligation may be a better option for innominate artery stenosis in selected patients.

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