Aketa Shuta, Wajima Daisuke, Kishi Masahiro, Morisaki Yudai, Yonezawa Taiji, Nakagawa Ichiro, Nakase Hiroyuki
Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan.
Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan; Department of Neurosurgery, Nara Medical University, Nara, Japan.
World Neurosurg. 2017 Sep;105:1040.e1-1040.e5. doi: 10.1016/j.wneu.2017.06.154. Epub 2017 Jul 3.
Symptomatic innominate artery stenosis presenting as hemodynamic bilateral cerebral ischemia is uncommon. We present a rare case of the severe stenosis of the origin of an innominate artery and severe stenosis of bilateral internal carotid artery that induced hemodynamic cerebral ischemia after ipsilateral axillary artery-bilateral femoral artery bypass and was treated with stent replacement of the innominate artery and right internal carotid artery.
A 64-year-old woman who previously had undergone right axillary artery-bilateral femoral artery anastomosis for abdominal aorta high obstruction had been suffering from chronic dizziness and so visited our department. Findings of the examination included the severe stenosis of the origin of an innominate artery and severe stenosis of bilateral internal carotid artery, causing hemodynamic cerebral ischemia. She underwent stent replacement of the innominate artery and right carotid artery stenting via a right transbrachial approach. Her symptoms were relieved postoperatively.
For the sake of improving the hemodynamic cerebral ischemia, we performed stent replacement for innominate artery stenosis and right carotid artery stenting. Endovascular treatment of subclavian and innominate artery disease is a safe procedure. In addition, for the protection of thromboembolic migration, we performed balloon protection of the external carotid artery and filter protection of the internal carotid artery.
Stent replacement for these lesions can be performed safely with the right approach and protection methods, even when the only accessible route is the right brachial artery.
表现为血流动力学双侧脑缺血的症状性无名动脉狭窄并不常见。我们报告一例罕见病例，无名动脉起始部严重狭窄合并双侧颈内动脉严重狭窄，在同侧腋动脉-双侧股动脉搭桥术后引发血流动力学脑缺血，经无名动脉及右颈内动脉支架置换治疗。
一名64岁女性，此前因腹主动脉高位梗阻接受了右腋动脉-双侧股动脉吻合术，一直患有慢性头晕，遂来我院就诊。检查发现无名动脉起始部严重狭窄及双侧颈内动脉严重狭窄，导致血流动力学脑缺血。她通过右肱动脉途径接受了无名动脉支架置换及右颈动脉支架置入术。术后症状缓解。
为改善血流动力学脑缺血，我们对无名动脉狭窄进行了支架置换并对右颈动脉进行了支架置入。锁骨下动脉和无名动脉疾病的血管内治疗是一种安全的手术。此外，为保护血栓栓塞迁移，我们对外颈动脉进行了球囊保护，对颈内动脉进行了滤网保护。
即使唯一可及的途径是右肱动脉，采用正确的方法和保护措施，对这些病变进行支架置换也可安全进行。
