title: Snare-assisted Trans-brachial Stenting for the Cervical Internal Carotid Artery Stenosis of Patient with Aorto-Iliac Occlusion. Technical Case Report.
abstract: We describe a case of endo-luminal stent placement with Snare-assist for a cervical internal carotid artery stenosis in which percutaneous access was obtained via the brachial artery. A 68-year-old man with known disease of the carotid, peripheral, and coronary arteries, with Human T-cell Lymphotrophic Virus type-1 (HTLV-1) Associated Myelopathy (HAM) presented for endoluminal revascularization of a severe, progressive right internal carotid artery stenosis, but with aorto-iliac occlusion. Transfemoral access was complicated by an aorto-iliac occlusion. A trans-brachial approach was successfully attempted, and a SMARTer stent (Cordis Endovascular, Miami Lakes, FL) was successfully placed through a 7-French Shuttle-SL guide sheath (Cook, Bloomington) under Snare-assist. The trans-brachial approach is becoming an increasingly viable alternative route for stent placement in patients with contra-indicated or complicated femoral access routes. As devices become increasingly more pliable and smaller, the trans-brachial route will be used with increasing frequency in the select patient population for stenting of both the cervical and intracranial circulation.
authors.affiliation: Department of Neurosurgery, Kyoto-Katsura Hospital, Corporation of Social Welfare, The Foundation for Social Services in Kyoto, Japan - hoowakievns@katsura-hp.jp.
authors.forename: H
authors.initials: H
authors.lastname: Oowaki
authors.forename: N
authors.initials: N
authors.lastname: Matsuura
authors.forename: M
authors.initials: M
authors.lastname: Ishikawa