Cerebral protection during retrograde brachiocephalic artery stenting using a single filter and increased subclavian steal phenomenon: illustrative case.

Autor:	Yanagihara W; 1Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan.; 2Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and., Akamatsu Y; 1Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan.; 2Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and., Shibanai K; 3Department of Neurosurgery, Kitakami Saiseikai Hospital, Kitakami, Iwate, Japan., Fujimoto K; 1Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan., Kojima D; 2Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and., Kashimura H; 2Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and., Kubo Y; 1Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan., Ogasawara K; 1Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2022 Jul 04; Vol. 4 (1), pp. CASE22194. Date of Electronic Publication: 2022 Jul 04 (Print Publication: 2022).
DOI:	10.3171/CASE22194
Abstrakt:	Background: Cerebral protection during brachiocephalic artery (BCA) stenting is important. However, the maneuver is sometimes challenging because both the internal carotid artery (ICA) and vertebral artery (VA) should be protected. Herein, the authors present an alternative cerebral protection technique involving filter protection for the ICA and hemodynamic protection for the VA during retrograde BCA stenting. Observations: A 64-year-old man with a thoracic aortic aneurysm presented with cold sensation and numbness in his right arm due to BCA stenosis. Endovascular stenting under cerebral protection was planned. Cerebral protection was attempted through the brachial access. Despite the successful placement of the filter in the ICA, selective catheterization of the VA failed. Furthermore, repeated transfemoral catheterization of the BCA was unsuccessful. Concerning a thoracic aortic aneurysm injury, the authors performed retrograde BCA stenting using a transbrachial approach. Hemodynamic protection of the VA was provided by increasing the subclavian steal phenomenon that resulted in successful recanalization of the BCA. Lessons: Retrograde BCA stenting performed while protecting the ICA with a filter and the right VA by increasing the subclavian steal phenomenon was successful. This simple technique is feasible, especially in patients with steno-occlusive lesions of the BCA concurrent with the dominant vertebra/vertebral collateral pathway. Competing Interests: Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. (© 2022 The authors.)
Databáze:	MEDLINE
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