Endovascular Cerebral Protection and Revascularization of Innominate Artery Stenosis Through Single-Site Access, with Device Entrapment and Rescue: Technical Case Report

We describe a novel technique for cerebral embolic device placement with inadvertent entrapment and subsequent rescue in the endovascular treatment of innominate artery stenosis. A 62-year-old female presented with symptomatic right-sided subclavian steal syndrome. Single-site access for revascularization of critical innominate artery stenosis with simultaneous cerebral embolic protection performed for this diagnosis has not been previously reported. Initial nontarget self-expanding stent deployment within the right subclavian artery resulted in entrapment of the embolic protection device. The device was retrieved through snare fixation and resheathing within a 6-French guide catheter navigated through common femoral artery access. Innominate artery balloon-mounted stent angioplasty was performed preceded by the embolic device retrieval, with complete resolution of symptoms. Endovascular distal protection device placement for prevention of cerebral atherothromboembolism during innominate artery stent angioplasty is not without risk and utilization needs to be carefully considered.