Case report: A hybrid open and endovascular approach for repairing a life-threatening innominate artery dissection using the simultaneous kissing stent technique

Frontiers in Neurology

Neurology

I-Chang Su¹  Shun-Tai Yang¹  Chu-Hsuan Kuo²  Yueh-Hsun Lu³  Yu-Chun Lu⁴ 

[1] Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan;Department of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan;Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan;Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan;Department of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan;

关键词: arterial dissection;    hybrid approach;    innominate artery;    kissing stent;    stenosis;   

DOI  :  10.3389/fneur.2023.1149236

 received in 2023-01-21, accepted in 2023-04-12,  发布年份 2023

来源: Frontiers

【 摘 要 】

Managing acute innominate artery (IA) dissection associated with severe stenosis is challenging due to its rarity, possible complex dissection patterns, and compromised blood flow to the brain and upper extremities. This report describes our treatment strategy for this challenging disease using the kissing stent technique. A 61-year-old man had worsening of an acute IA dissection secondary to an extension of a treated aortic dissection. Four possible treatment strategies for kissing stent placement were proposed based on different approaches (open surgical or endovascular) and accesses (trans-femoral, trans-brachial, or trans-carotid access). We chose to place two stents simultaneously via a percutaneous retrograde endovascular approach through the right brachial artery and a combined open surgical distal clamping of the common carotid artery with a retrograde endovascular approach through the carotid artery. This hybrid approach strategy highlights the three key points for maintaining safety and efficacy: (1) good guiding catheter support is obtainable through retrograde, rather than antegrade, access to the lesion, (2) concomitant cerebral and upper extremity reperfusion is guaranteed by placing kissing stents into the IA, and (3) peri-procedural cerebral emboli are prevented by surgical exposure of the common carotid artery with distal clamping.

【 授权许可】

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Copyright © 2023 Kuo, Yang, Lu, Lu and Su.