Balloon expandable stent implantation after iatrogenic arterial dissection of the left subclavian artery

Combined Operative and Endovascular Treatment of a Post-Traumatic Embolizing Aneurysm of the Subclavian Artery

Purpose:

To describe a combined endovascular and surgical approach for an embolizing subclavian artery aneurysm as an alternative to conventional reconstructive surgery.

Methods and Results:

A 39-year-old woman presented with a post-traumatic aneurysm of the left subclavian artery and occlusion of the brachial artery due to embolization. Exclusion of the aneurysm was achieved by intraoperative implantation of a covered stent during simultaneous reconstruction of the brachial artery by a venous bypass graft. The patient is well and free of symptoms 24 months after the operation.

Conclusions:

Repeat operative trauma to the supraclavicular region was avoided by transluminal implantation of a covered stent-graft in combination with an axilloulnar bypass procedure for chronic embolic occlusion of the brachial artery.

Complete stent fracture 1 year after LIMA PCI due to LIMA and subclavian artery dissection

Stent platforms are prone to fracture while incidental data are demonstrating a potential unfavorable outcome. Predisposing factors usually involve long lesions and tortuous vessels requiring more than one stent. This issue is magnified when it involves a periprocedural iatrogenic left internal mammary artery (LIMA) and subclavian artery dissection. In such complex clinical scenarios, the risk of potential complications including stent fractures is thought to be higher, though there is no data to determine the prognosis or to outline the outcomes of any management option. We present a case of complete stent fracture 1 year after LIMA percutaneous coronary intervention due to LIMA and subclavian artery dissection highlighting the circumstantial evidence in the literature that guided our management decisions.

Treatment of an iatrogenic subclavian artery dissection

Subclavian artery dissection is a rare complication of cardiac catheterization. The usual reason for entering this vessel is to access the origin of the left internal mammary artery (LIMA) when this has previously been used, or is being considered, as a bypass graft. We report an instance of such dissection occurring long after bypass surgery which had included a LIMA graft. Successful correction was achieved by angioplasty and stent placement, using a retrograde left brachial approach.

Complicated stent supported cerebrovascular angioplasty: case analyses and review of literature

BACKGROUND

Hemodynamic lesions of the cervicocerebral vasculature are currently being treated with stent supported percutaneous transluminal angioplasty. These procedures have met with increasing success when compared to the risks and morbidity of more invasive surgical approaches. The versatility of stent-supported angioplasty as a primary therapeutic modality is examined in the following complex cases.

CASE DESCRIPTION

We present four cases involving cervical angioplasty with emergent or adjunctive stent placement. Two cases involved the subclavian arteries, whereas the others involved the vertebral and internal carotid arteries. In our experience, complications of cervicocerebral artery angioplasty have been successfully managed by stent placement.

CONCLUSION

Our cases demonstrate the emerging role of cervical angioplasty and stent implantation as a successful therapeutic modality, highlighted in these complex cases.

Combined operative and endovascular treatment of a post-traumatic embolizing aneurysm of the subclavian artery

PURPOSE

To describe a combined endovascular and surgical approach for an embolizing subclavian artery aneurysm as an alternative to conventional reconstructive surgery.

METHODS AND RESULTS

A 39-year-old woman presented with a post-traumatic aneurysm of the left subclavian artery and occlusion of the brachial artery due to embolization. Exclusion of the aneurysm was achieved by intraoperative implantation of a covered stent during simultaneous reconstruction of the brachial artery by a venous bypass graft. The patient is well and free of symptoms 24 months after the operation.

CONCLUSIONS

Repeat operative trauma to the supraclavicular region was avoided by transluminal implantation of a covered stent-graft in combination with an axilloulnar bypass procedure for chronic embolic occlusion of the brachial artery.

Supra-aortic arterial stenoses: management with Palmaz balloon-expandable intraluminal stents

PURPOSE

The authors report on the use of Palmaz balloon-expandable intraluminal metallic stents to supplement conventional balloon angioplasty and to primarily treat a variety of supra-aortic arterial atherosclerotic lesions manifested by claudication or embolic phenomena.

PATIENTS AND METHODS

Results from a series of seven patients are reported. Five patients received stents following percutaneous balloon angioplasty (PTA): four patients received five stents for suboptimal initial result of PTA and one patient received one stent for early restenosis following successful PTA. Two patients received three stents primarily: one patient had one stent placed for a highly eccentric innominate lesion and the other patient had two stents placed for an ulcerated nonocclusive subclavian lesion causing blue digits.

RESULTS

Treatment produced immediate angiographic or hemodynamic improvement in all seven patients. Clinical follow-up was obtained on all patients (mean, 10 months; range, 3-18 months). One patient had an episode of vertigo after PTA of a right subclavian lesion that resolved after thrombolytic therapy and stent placement.

CONCLUSION

The placement of metallic stents in supra-aortic arteries represented an effective adjunct to PTA of atherosclerotic stenoses in these vessels. Primary stent placement may be an effective treatment for selected lesions.