Chapter 99 - Brachiocephalic artery disease - endovascular Flashcards
Concomitant arch disease in patients with carotid bifurcation disease
5-15%
Most common arch vessel disease
Left subclavian
Rate of concurrent innominate and LCCA disease
30%
Percentage of LCCA from innominate artery
20%
Percentage of left vert from aortic arch directly
6%
Best angle to see innominate origin
20 degrees RAO
Best angle to see aortic arch
LAO
Unfavorable features to endo arch vessel disease
1) occlusion
2) eccentric lesions
3) vessel origin in ascending aorta
4) heavy calcification
5) ulceration
6) symptomatic
7) ostial lesion
8) plaque abutting vertebral artery origin
Angioplasty of arch vessel vs stent
Angioplasty + selective stent vs primary stent
patency the same, 89% 23 mth and long term 77-80%
DAPT vs DAPT + glycoprotein IIb/IIIa inhibitor in arch stenting
increases bleeding
DAPT only is better
Predilation balloon key points
1) 4-6 mm for arch vessel enough
2) length should be slightly bigger so the balloon won’t slip
3) diameter should be smaller so no dissection
amount of protrusion of stent into aorta
1-2 mm
Results of concurrent CEA and proximal CAS
30 day
stroke 1.5%
mortality 0.7%
only done if both hemodynamically significant
Arch stent patency 5 years
77-89%
AbuRahma endo vs open
complication similar
patency at 1, 3, 5 years
endo 93, 78, 70
open 100, 98, 96
other studies confirm
