1
|
Kuwabara M, Sakamoto S, Okazaki T, Ishii D, Hosogai M, Maeda Y, Horie N. Usefulness of stent placement for innominate artery stenosis via the right brachial artery under protection by balloon guide catheter: a technical case report. Acta Neurochir (Wien) 2022; 164:2875-2880. [PMID: 36151329 DOI: 10.1007/s00701-022-05367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/10/2022] [Indexed: 01/31/2023]
Abstract
A method of cerebral protection during endovascular treatment for innominate artery stenosis (IAS) has not been established. Herein, we report a case of symptomatic IAS in a 76-year-old woman. A balloon guide catheter (BGC) was inserted through the right brachial artery (BA) and guided distally to the stenosis. The BGC balloon was inflated, and stenting was performed with balloon protection of both the anterior and posterior cerebral circulation, without any complications. Stenting of the IAS with the BGC using the BA approach is useful, as it is a simple technique that can prevent distal embolization.
Collapse
Affiliation(s)
- Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan.
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Masahiro Hosogai
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Yuyo Maeda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| |
Collapse
|
2
|
Ishikawa T, Yamazaki T, Sato M, Kato N, Ishikawa E, Matsumaru Y, Matsumura A. Endovascular Stent Grafting for Recurrent Strokes Due to Fragile Innominate Artery Plaque: A Case Report. NMC Case Rep J 2021; 8:21-25. [PMID: 34012744 PMCID: PMC8116917 DOI: 10.2176/nmccrj.cr.2020-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022] Open
Abstract
Here we describe a case of recurrent ischemic strokes due to fragile innominate artery plaque successfully treated using endovascular stent grafting. An 80-year-old man presented with a history of recurrent strokes that were refractory to medical treatment. Computed tomography and magnetic resonance images of the thorax revealed a gross intramural plaque in the innominate artery. He was successfully treated using endovascular stent grafting. An AFX stent graft device was used to prevent further embolic strokes. The AFX stent graft has a unique endoskeleton design with a thin-walled expanded polytetrafluoroethylene fabric—known as active sealing structure—attached to the implant. Postoperatively, the patient has experienced no recurrent strokes in over 2 years of follow-up. The stent grafting procedure could be an optimal treatment option for treating fragile innominate artery plaques.
Collapse
Affiliation(s)
- Takaaki Ishikawa
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Ibaraki, Ibaraki, Japan
| | - Tomosato Yamazaki
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Ibaraki, Ibaraki, Japan
| | - Masataka Sato
- Department of Cardiovascular Surgery, National Hospital Organization, Mito Medical Center, Ibaraki, Ibaraki, Japan
| | - Noriyuki Kato
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Ibaraki, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| |
Collapse
|
3
|
Ikenouchi H, Washida K, Yoshimoto T, Fukuma K, Saito S, Inoue Y, Matsuda H, Ihara M. Balloon-like Mobile Plaque in the Innominate Artery: Ultrasonographic and Pathological Perspectives of Repetitive Embolism. J Stroke Cerebrovasc Dis 2019; 28:e95-e97. [PMID: 31053373 DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022] Open
Abstract
Mobile plaque in the innominate artery is extremely rare and difficult to diagnose, especially in its acute stage. Its diagnosis is often delayed in many cases, resulting in delayed treatment and poor prognosis. Herein, we report the case of a 69-year-old patient with multiple cerebral infarction only in the right internal carotid artery and vertebrobasilar territories. No embolic sources were found until arterial ultrasonography detected a large balloon-like mobile plaque in the IA. Mobile plaque consisted of high-and low-echoic components and showed balloon-like plaque. Despite sufficient antiplatelet therapy, recurrence of cerebral embolism could not be prevented. IA replacement was eventually performed by cardiac surgeons. Pathological examinations showed that organized mobile plaque could have existed previously and acute thrombi, generated after the atheromatous plaque rupture caused by the mechanical burden of organized mobile plaque, could expand along with the organized mobile plaque and caused balloon-like plaque and related with repeated embolism. The IA should be explored immediately in cases of repetitive right-sided cerebral embolisms to prevent further recurrence.
Collapse
Affiliation(s)
- Hajime Ikenouchi
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan
| | - Kazuo Washida
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan.
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan
| | - Kazuki Fukuma
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan
| | - Satoshi Saito
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan
| |
Collapse
|