Advances in Brachiocephalic Angioplasty.

was introduced into brachiocephalic angioplasty. This report is based on 299 performed angioplasty procedures. This number is divided as follows: innominate artery 7 (2 with stents), left subclavian artery 49 (15 with stents), right subclavian artery 18 (5 with stents), left common carotid artery 12 (6 with stents), right common carotid artery 5 (3 with stents), external carotid artery 21 (1 with stent), left internal carotid artery 5 (2 with stents), right internal carotid artery (2 with stents), bifurcation of the left common carotid artery 88 (85 with stents), bifurcation of the right common carotid artery 67 (60 with stents), left vertebral artery 16 (8 with stents), right vertebral artery 9 (6 with stents). The following are examples in which the angioplasty could not be fully successful without the use of stents. The first example was a young woman with a traumatic dissection and pseudoaneurysm on the right internal carotid artery. A 20 mm Palmaz-Schatz (Cordis, Miami, FL) stent was placed within the stenotic segment and at the level of the pseudoaneurysm below the base. A 4–month controlled arteriogram showed normal appearance of the right internal carotid artery. The second patient was a middle–aged woman who developed left–sided ear bruit. An arteriogram showed fibromuscular dysplasia on the left internal carotid artery with a 90% stenosis. An angioplasty was performed and two 20 mm Palmaz-Schatz stents were placed. A six–month controlled arteriogram showed a normal appearance of the internal carotid artery. The third patient of this group, was a woman with a spontaneous dissection on the right internal carotid artery who developed several TIA’s with a left–sided hemiparesis. An arteriogram showed almost complete occlusion of the right internal carotid artery just below the base of the scull. An angioplasty was performed, and a Cook Flex stent (Bloomington, IN) was placed within the petrous portion of the internal carotid artery, followed by Palmaz-Schatz stents on the neck portion of the same vessel. A controlled arteriogram was performed 2 days later showing a normal right internal carotid artery and a normal intercranial vasculature. Angioplasty of the subclavian artery is an accepted procedure performed routinely in a multiple of centers. Stent placement is very useful especially if the stenoses is located close to the ostium of the vessel or if dissection during the angioplasty develops. The next example was an angioplasty and recanalization of a completely occluded right common carotid artery with patent external and internal carotid arteries. Significant stenosis was seen at the origin of the right subclavian artery as well. This stenosis was opened and a Palmaz-Schatz stent was placed within the origin of the right subclavian artery. An angioplasty of the right common carotid artery was performed and a Wallstent Advances in Brachiocephalic Angioplasty