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A Single-Center Experience Using Cerebral Protection

Brian G. Peterson, MD; Scott A. Resnick, MD; Mark D. Morasch, MD; Heitham T. Hassoun, MD; Mark K. Eskandari, MD

Arch Surg. 2006;141:560-564.

Hypothesis  Endovascular interventions have revolutionized the contemporary treatment of peripheral vascular occlusive disease. Traditional management of supra-aortic trunk disease has employed surgical extra-anatomic bypass via a cervical approach or median sternotomy. Endoluminal therapy may be a less morbid alternative.

Design and Setting  A retrospective review of procedures performed by vascular surgeons in an operating room angiosuite at a single university-based, tertiary referral center.

Patients  Eighteen consecutive patients with 20 brachiocephalic-origin stenoses.

Interventions  From December 2001 through September 2005, 20 brachiocephalic-origin stenoses were treated endoluminally with balloon-expandable stents. Treated vessels were innominate (n = 8), common carotid (n = 9), and subclavian (n = 3). The target lesion was accessed by one of the following methods: antegrade via the femoral artery (n = 5), retrograde through the brachial artery (n = 1), or via a retrograde cut-down on the common carotid artery (n = 14). Cerebral protection was achieved with either a distal embolic filter device or with open surgical occlusion of the distal common carotid artery.

Main Outcome Measures  We report immediate and midterm outcomes of all aortic arch vessel stenting procedures with mean follow-up of 12 months.

Results  Mean age was 68 years (6 men and 12 women) and overall mean stenosis was 85%. Preprocedural symptoms including stroke, transient ischemic attack, arm fatigue, digital ischemia, and angina were present in 16 of 20 cases (80%). The 4 asymptomatic patients all had more than 90% stenosis on angiography. At 30-day follow-up, there were no deaths, myocardial infarctions, or strokes. During follow-up, there were no cases of restenosis.

Conclusion  Endoluminal arterial stenting of brachiocephalic arch vessels may be a viable alternative to traditional open bypass in cases of focal stenotic disease.

Author Affiliations: Division of Vascular Surgery (Drs Peterson, Resnick, Morasch, Hassoun, and Eskandari) and Department of Radiology (Drs Resnick and Eskandari), Northwestern University Feinberg School of Medicine, Chicago, Ill.

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