• Shuta Aketa, Daisuke Wajima, Masahiro Kishi, Yudai Morisaki, Taiji Yonezawa, Ichiro Nakagawa, and Hiroyuki Nakase.
• Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan.
• World Neurosurg. 2017 Sep 1; 105: 1040.e1-1040.e5.

BackgroundSymptomatic innominate artery stenosis presenting as hemodynamic bilateral cerebral ischemia is uncommon. We present a rare case of the severe stenosis of the origin of an innominate artery and severe stenosis of bilateral internal carotid artery that induced hemodynamic cerebral ischemia after ipsilateral axillary artery-bilateral femoral artery bypass and was treated with stent replacement of the innominate artery and right internal carotid artery.Case ReportA 64-year-old woman who previously had undergone right axillary artery-bilateral femoral artery anastomosis for abdominal aorta high obstruction had been suffering from chronic dizziness and so visited our department. Findings of the examination included the severe stenosis of the origin of an innominate artery and severe stenosis of bilateral internal carotid artery, causing hemodynamic cerebral ischemia. She underwent stent replacement of the innominate artery and right carotid artery stenting via a right transbrachial approach. Her symptoms were relieved postoperatively.DiscussionFor the sake of improving the hemodynamic cerebral ischemia, we performed stent replacement for innominate artery stenosis and right carotid artery stenting. Endovascular treatment of subclavian and innominate artery disease is a safe procedure. In addition, for the protection of thromboembolic migration, we performed balloon protection of the external carotid artery and filter protection of the internal carotid artery.ConclusionsStent replacement for these lesions can be performed safely with the right approach and protection methods, even when the only accessible route is the right brachial artery.Copyright © 2017 Elsevier Inc. All rights reserved.

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