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Surgical and endovascular treatment of stenosis of the innominate artery.

BACKGROUND
Atherosclerotic lesions of the brachiocepfialic trunk are relatively rare compared with other types of vascular diseases. Median sternotomy with direct endothoracic repair is recommended because of good early and long-term results. Nevertheless, this procedure is not without risks such as hemorrhaging, embolism, aortic dissection, infection or death.


METHODS
This report therefore, describes our experience in intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk with cerebral protection ensured by common carotid artery clamping. Through an anterolateral cervical approach the right common carotid artery was surgically exposed. After dilating the brachiocephalic trunk and positioning the stent, the vessel was repaired with a continuous suture.


RESULTS
In all patients the dilation of the stenosis of the brachiocephalic trunk and the stent placement were successful without any side-effects. No distal embolism with neurologic events, innominate artery dissection, rupture, occlusion or neck hematoma occurred. All patients were discharged three days after the intervention.


CONCLUSIONS
This technique offers a safe, effective approach to stenoses of innominate arteries because it is less invasive than conventional transthoracic or extrathoracic surgery and offers excellent early and mid-term results. We believe that this technique is a safe and effective alternative to conventional surgery.