Neurointervention.  2022 Mar;17(1):45-49. 10.5469/neuroint.2021.00472.

Y Stent Rendezvous to Treat Symptomatic Innominate Artery Stenosis

Affiliations
  • 1Department of Radiology, Austin Health, Melbourne, VIC, Australia

Abstract

A male in his 60s presented with transient ischemic attacks 5 years after aortic arch branch graft repair for type A aortic dissection. Computed tomographic angiography demonstrated 80% stenosis of the brachiocephalic artery close to the origins of the right common carotid and subclavian arteries. The case was reviewed at our multidisciplinary aortic meeting and a plan for endovascular management was made. Percutaneous endovascular Y stenting from the innominate artery into the left common carotid and subclavian arteries was achieved using self-expanding nitinol stents with a rendezvous technique that included retrograde right radial artery, retrograde right external carotid artery, and retrograde right femoral arterial approaches. At 6 months review, the stents remained widely patent and the patient was symptom-free.

Keyword

Ischemic attack, transient; Transient; Stents; Endovascular procedures; Brachiocephalic trunk; Radial artery

Figure

  • Fig. 1. Concept sketch of the procedural plan. Image (A) confirms ECA/radial and femoral access with wires (dotted lines) crossing the stenosis (★) of the innominate branch graft. Image (B) imaging demonstrates the monorail/chaperone system of the balloon catheter and stent device. Image (C) shows the expected position and appearance of the Y stent configuration. ECA, external carotid artery.

  • Fig. 2. Images (A–D) show sequential mobilization of the stent (long arrow) via balloon-stent device chaperone (small arrow) across the stenosis (★).

  • Fig. 3. Pre-treatment angiogram confirms high-grade stenosis (★) of the innominate branch graft. Both radial and femoral catheters are demonstrated (arrows) (A). Post-stent deployment across the stenosis (★) shown in (B). The stent device was fashioned ex-vivo for education in image (C).


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