Case report: A hybrid open and endovascular approach for repairing a life-threatening innominate artery dissection using the simultaneous kissing stent technique
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...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1149236/full |
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| author | Chu-Hsuan Kuo Shun-Tai Yang Shun-Tai Yang Shun-Tai Yang Yueh-Hsun Lu Yueh-Hsun Lu Yu-Chun Lu Yu-Chun Lu I-Chang Su I-Chang Su I-Chang Su |
| author_facet | Chu-Hsuan Kuo Shun-Tai Yang Shun-Tai Yang Shun-Tai Yang Yueh-Hsun Lu Yueh-Hsun Lu Yu-Chun Lu Yu-Chun Lu I-Chang Su I-Chang Su I-Chang Su |
| author_sort | Chu-Hsuan Kuo |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T14:17:50Z |
| format | Article |
| id | doaj.art-cfc2db06e5a24d15a6371a99d2a19594 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-09T14:17:50Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-cfc2db06e5a24d15a6371a99d2a195942023-05-05T06:09:52ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-05-011410.3389/fneur.2023.11492361149236Case report: A hybrid open and endovascular approach for repairing a life-threatening innominate artery dissection using the simultaneous kissing stent techniqueChu-Hsuan Kuo0Shun-Tai Yang1Shun-Tai Yang2Shun-Tai Yang3Yueh-Hsun Lu4Yueh-Hsun Lu5Yu-Chun Lu6Yu-Chun Lu7I-Chang Su8I-Chang Su9I-Chang Su10Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, TaiwanDepartment of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, TaiwanTaipei Neuroscience Institute, Taipei Medical University, Taipei City, TaiwanDepartment of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, TaiwanDepartment of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, TaiwanDepartment of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, TaiwanTaipei Neuroscience Institute, Taipei Medical University, Taipei City, TaiwanDepartment of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, TaiwanDepartment of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, TaiwanTaipei Neuroscience Institute, Taipei Medical University, Taipei City, TaiwanDepartment of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, TaiwanManaging 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.https://www.frontiersin.org/articles/10.3389/fneur.2023.1149236/fullarterial dissectionhybrid approachinnominate arterykissing stentstenosis |
| spellingShingle | Chu-Hsuan Kuo Shun-Tai Yang Shun-Tai Yang Shun-Tai Yang Yueh-Hsun Lu Yueh-Hsun Lu Yu-Chun Lu Yu-Chun Lu I-Chang Su I-Chang Su I-Chang Su 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 arterial dissection hybrid approach innominate artery kissing stent stenosis |
| title | Case report: A hybrid open and endovascular approach for repairing a life-threatening innominate artery dissection using the simultaneous kissing stent technique |
| title_full | Case report: A hybrid open and endovascular approach for repairing a life-threatening innominate artery dissection using the simultaneous kissing stent technique |
| title_fullStr | Case report: A hybrid open and endovascular approach for repairing a life-threatening innominate artery dissection using the simultaneous kissing stent technique |
| title_full_unstemmed | Case report: A hybrid open and endovascular approach for repairing a life-threatening innominate artery dissection using the simultaneous kissing stent technique |
| title_short | Case report: A hybrid open and endovascular approach for repairing a life-threatening innominate artery dissection using the simultaneous kissing stent technique |
| title_sort | case report a hybrid open and endovascular approach for repairing a life threatening innominate artery dissection using the simultaneous kissing stent technique |
| topic | arterial dissection hybrid approach innominate artery kissing stent stenosis |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1149236/full |
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