title: Feasibility and Safety of Distal and Proximal Combined Endovascular Approach with a Balloon-Guiding Catheter for Subclavian Artery Total Occlusion.
abstract: BACKGROUND
  Symptomatic subclavian artery total occlusion is widely treated with an endovascular procedure that often results in distal vertebral artery embolism. Therefore, protection devices are important. Establishing a filter or balloon device in the vertebral artery can protect against this distal embolism. However, the use of embolic protection devices is not easy, and it makes the procedure more complicated. Here, we report a case of symptomatic subclavian artery total occlusion that was treated successfully with a balloon-guiding catheter and the pull-through technique.
  
  
  METHODS
  A 67-year-old man developed intermittent motor weakness in his left arm. Aortic angiography demonstrated a complete occlusion of the left proximal subclavian artery and a retrograde flow through the left vertebral artery to the distal brachial artery. In this case, we used a balloon-guiding catheter and the pull-through technique to prevent distal embolism. The balloon-guiding system was useful not only for embolic protection but also for scaffold during excavation and for the centering effect against invisible vessels. The pull-through technique enabled our devices to deliver easily and smoothly. The patient was treated successfully without complications.
  
  
  CONCLUSIONS
  The distal and proximal combined endovascular treatment with a transbrachial balloon-guiding catheter is a beneficial treatment option for patients with subclavian artery total occlusion.
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors.forename: Taiki
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan. Electronic address: tomotaka.oshima@toyota-kai.or.jp.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ohshima
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Ishikawa
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors.forename: Shunsaku
authors.initials: S
authors.lastname: Goto
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tamari
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D013349:Subclavian Steal Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Percutaneous transluminal angioplasty; Stenting; Subclavian artery; Subclavian steal syndrome