title: Percutaneous and open retrograde endovascular stenting of symptomatic high-grade innominate artery stenosis: technique and follow-up.
abstract: OBJECTIVE
  Angioplasty and stenting of the IA have been reported with high technical and clinical success rates, low complication rates and good mid-term patency rates. Different antegrade or retrograde endovascular catheter-based approaches and combinations with surgical exposure of the CCA are used. The purpose of this study was to determine safety, efficacy and mid-term clinical and radiological outcome of the stent-assisted treatment of atherosclerotic stenotic disease of the IA with special focus on the different technical approaches.
  
  
  METHODS
  Between 1996 and 2008, 18 patients (12 men, 6 women) with symptomatic high-grade stenosis (>80%) of the IA were treated with endovascular stent placement. Their mean age was 60.4 years (range, 48-78 years). Mean angiographic and clinical follow-up was 2.7 years (range, 0.3-9.1 years). Clinical follow-up was performed by using the mRS at hospital discharge, routine follow-up controls, and a questionnaire. In 11 patients, a percutaneous approach was used. In 7 patients, the lesions were accessed retrogradely through a cervical cut-down with common carotid arteriotomy. In 2 patients, a simultaneous ipsilateral carotid endarterectomy was performed.
  
  
  RESULTS
  In all patients, primary stent placement was performed. There were 2 procedure-related transient complications (11.1%) due to cerebral embolism without permanent morbidity or mortality. During the follow-up, all patients showed improvement of the preprocedural symptoms. At the latest clinical follow-up (mean, 2.7 years), all patients showed an excellent or good outcome (mRS, 0 or 1). In 2 patients (11.1%), a secondary stent placement was needed due to a significant symptomatic in-stent stenosis.
  
  
  CONCLUSIONS
  Percutaneous and open retrograde stenting of high-grade stenosis of the IA is a viable less invasive alternatives to open bypass surgery with good midterm clinical results and patency rates.
authors.affiliation: Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Mordasini
authors.forename: J
authors.initials: J
authors.lastname: Gralla
authors.forename: D-D
authors.initials: DD
authors.lastname: Do
authors.forename: J
authors.initials: J
authors.lastname: Schmidli
authors.forename: B
authors.initials: B
authors.lastname: Keserü
authors.forename: M
authors.initials: M
authors.lastname: Arnold
authors.forename: U
authors.initials: U
authors.lastname: Fischer
authors.forename: G
authors.initials: G
authors.lastname: Schroth
authors.forename: C
authors.initials: C
authors.lastname: Brekenfeld
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000379:methods*; D016122:Brachiocephalic Trunk / Q000473:pathology*; D002560:Cerebrovascular Circulation; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000473:pathology* / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome