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Distal neuroprotection system as option for right subclavian artery ostial recanalization.

Misztal M, Pieniążek P, Zasada J, Brzychczy A, Nessler J, Zmudka K - Postepy Kardiol Interwencyjnej (2013)

Bottom Line: We present the case of a 49-year-old woman with neurological symptoms and severe atherosclerosis of aortic arch branches affecting subclavian and carotid arteries.We present a double access intervention using a distal embolic neuroprotection device during ostial right subclavian artery recanalization.We recommend that use of an embolic protection device in right subclavian artery ostial recanalization should be considered.

View Article: PubMed Central - PubMed

Affiliation: Coronary Artery Disease Department, Institute of Cardiology, Jagiellonian University, John Paul II Hospital, Krakow, Poland.

ABSTRACT
We present the case of a 49-year-old woman with neurological symptoms and severe atherosclerosis of aortic arch branches affecting subclavian and carotid arteries. Our patient has a history of transient ischemic attack and recurrent paresthesias of her right arm. We present a double access intervention using a distal embolic neuroprotection device during ostial right subclavian artery recanalization. We recommend that use of an embolic protection device in right subclavian artery ostial recanalization should be considered.

No MeSH data available.


Related in: MedlinePlus

A – MPR CT reconstruction of innominate, right subclavian and common carotid arteries. B – CT scan (MIP) showing ostial occlusion of right subclavian artery (no signs of calcifications)
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Figure 0002: A – MPR CT reconstruction of innominate, right subclavian and common carotid arteries. B – CT scan (MIP) showing ostial occlusion of right subclavian artery (no signs of calcifications)

Mentions: A 49-year-old woman was referred to our department in February 2012 after transient ischemic attack (TIA) of the left hemisphere observed in January 2012. Prior to TIA the patient reported transient paresthesias of the right upper limb and left part of her face and very acute and short speech problems. Doppler ultrasound performed in the department of neurology revealed critical stenosis > 90% (PSV – 7.5 m/s) of the left internal carotid artery (LICA) and occlusion of the right subclavian artery (RSA) with subclavian steal syndrome (SSS). In the brain computed tomography (CT) there were no signs of ischemic lesions. Blood pressure measurements confirmed 40–50 mm Hg asymmetry in the systolic blood pressure between arms. The patient presented a few atherosclerosis risk factors, e.g. hypertension, hyperlipidemia, obesity, diabetes mellitus and nicotine abuse. As a first step we decided to perform carotid artery stenting (CAS) as a primary prevention of the stroke. The procedure was done at the beginning of March 2012 using a proximal protection Mo.Ma 8 Fr device (Medtronic, US) and implantation of a self-expanding Cristallo Ideale 6-9/40 mm tapered stent (Medtronic, US). During catheterization a steal syndrome of the right subclavian artery through the left vertebral artery was visualized (Figure 1). After carotid artery stenting (CAS-LICA) the patient was put on dual antiplatelet therapy with a high dose of statin and was discharged home with scheduled angio-CT of innominate and right subclavian arteries. Three months later the patient visited the out-patient clinic complaining of right arm weakness and claudication, loss of precision within the right hand and recurrent dizziness. She also presented her CT scans confirming short, soft occlusion of the orifice of the RSA (Figure 2).


Distal neuroprotection system as option for right subclavian artery ostial recanalization.

Misztal M, Pieniążek P, Zasada J, Brzychczy A, Nessler J, Zmudka K - Postepy Kardiol Interwencyjnej (2013)

A – MPR CT reconstruction of innominate, right subclavian and common carotid arteries. B – CT scan (MIP) showing ostial occlusion of right subclavian artery (no signs of calcifications)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927106&req=5

Figure 0002: A – MPR CT reconstruction of innominate, right subclavian and common carotid arteries. B – CT scan (MIP) showing ostial occlusion of right subclavian artery (no signs of calcifications)
Mentions: A 49-year-old woman was referred to our department in February 2012 after transient ischemic attack (TIA) of the left hemisphere observed in January 2012. Prior to TIA the patient reported transient paresthesias of the right upper limb and left part of her face and very acute and short speech problems. Doppler ultrasound performed in the department of neurology revealed critical stenosis > 90% (PSV – 7.5 m/s) of the left internal carotid artery (LICA) and occlusion of the right subclavian artery (RSA) with subclavian steal syndrome (SSS). In the brain computed tomography (CT) there were no signs of ischemic lesions. Blood pressure measurements confirmed 40–50 mm Hg asymmetry in the systolic blood pressure between arms. The patient presented a few atherosclerosis risk factors, e.g. hypertension, hyperlipidemia, obesity, diabetes mellitus and nicotine abuse. As a first step we decided to perform carotid artery stenting (CAS) as a primary prevention of the stroke. The procedure was done at the beginning of March 2012 using a proximal protection Mo.Ma 8 Fr device (Medtronic, US) and implantation of a self-expanding Cristallo Ideale 6-9/40 mm tapered stent (Medtronic, US). During catheterization a steal syndrome of the right subclavian artery through the left vertebral artery was visualized (Figure 1). After carotid artery stenting (CAS-LICA) the patient was put on dual antiplatelet therapy with a high dose of statin and was discharged home with scheduled angio-CT of innominate and right subclavian arteries. Three months later the patient visited the out-patient clinic complaining of right arm weakness and claudication, loss of precision within the right hand and recurrent dizziness. She also presented her CT scans confirming short, soft occlusion of the orifice of the RSA (Figure 2).

Bottom Line: We present the case of a 49-year-old woman with neurological symptoms and severe atherosclerosis of aortic arch branches affecting subclavian and carotid arteries.We present a double access intervention using a distal embolic neuroprotection device during ostial right subclavian artery recanalization.We recommend that use of an embolic protection device in right subclavian artery ostial recanalization should be considered.

View Article: PubMed Central - PubMed

Affiliation: Coronary Artery Disease Department, Institute of Cardiology, Jagiellonian University, John Paul II Hospital, Krakow, Poland.

ABSTRACT
We present the case of a 49-year-old woman with neurological symptoms and severe atherosclerosis of aortic arch branches affecting subclavian and carotid arteries. Our patient has a history of transient ischemic attack and recurrent paresthesias of her right arm. We present a double access intervention using a distal embolic neuroprotection device during ostial right subclavian artery recanalization. We recommend that use of an embolic protection device in right subclavian artery ostial recanalization should be considered.

No MeSH data available.


Related in: MedlinePlus