Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2019; 7(17): 2644-2651
Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2644
Brachiocephalic artery stenting through the carotid artery: A case report and review of the literature
Fang Xu, Feng Wang, Yong-Sheng Liu
Fang Xu, Feng Wang, Yong-Sheng Liu, Department of Interventional Therapy, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
Author contributions: Xu F performed clinical examination and collected the data; Xu F, Wang F, and Liu YS designed the report, analyzed the data, and wrote the paper; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient's daughters for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Feng Wang, MD, PhD, Chief Doctor, Professor, Surgeon, Teacher, Department of Interventional Therapy, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan District, Dalian 116000, Liaoning Province, China.
Telephone: +86-411-83635963
Received: May 15, 2019
Peer-review started: May 21, 2019
First decision: July 30, 2019
Revised: August 14, 2019
Accepted: August 20, 2019
Article in press: August 20, 2019
Published online: September 6, 2019

As the population ages and people’s living standards gradually improve, the incidence of cerebrovascular disease in China is increasing annually, posing a serious threat to people’s health. The incidence of brachiocephalic artery stenosis in ischemic cerebrovascular disease is relatively low, accounting for 0.5% to 2% of patients, but its consequences are very serious. Herein, we report a case of brachiocephalic artery stenting through the carotid artery.


The patient was a 66-year-old man. He came to our hospital because of repeated dizziness and was diagnosed with ischemic cerebrovascular disease (stenosis at the beginning of the brachiocephalic artery). Cerebral angiography suggested that the stenosis of the brachiocephalic artery had almost occluded it. Contrast agent threaded a line through the stenosis, and there was reversed blood flow through the right vertebral artery to compensate for the subclavian steal syndrome in the right subclavian artery. To improve the symptoms, we placed an Express LD (8 mm × 37 mm) balloon expanding stent in the stenosis section. After the operation, the patient’s dizziness significantly improved. However, after 6 mo, the patient was re-admitted to the hospital due to dizziness. A computed tomography scan of the head revealed multiple cerebral infarctions in bilateral basal ganglia and the right lateral ventricle. An auxiliary examination including computerized tomography angiography of the vessels of the head and cerebral angiography both showed severe stenosis in the brachiocephalic artery stent. During the operation, the guidewire and catheter were matched to reach the opening of the brachiocephalic artery. Therefore, we decided to use a right carotid artery approach to complete the operation. We sutured the neck puncture point with a vascular stapler and then ended the operation. After the operation, the patient recovered well, his symptoms related to dizziness disappeared, and his right radial artery pulsation could be detected.


In patients with brachial artery stenosis, when the femoral artery approach is difficult, the carotid artery is an unconventional but safe and effective approach. At the same time, the use of vascular suturing devices to suture a carotid puncture point is also commendable. Although it is beyond the published scope of the application, when used cautiously, it can effectively avoid cerebral ischemia caused by prolonged artificial compression, and improper suturing can lead to stenosis of the puncture site and improper blood pressure, resulting in the formation of a hematoma. Finally, satisfactory hemostasis can be achieved.

Keywords: Stenosis of the brachiocephalic artery, Trans-carotid approach, Vascular stapler, Case report

Core tip: Ischemic cerebrovascular disease is one of the diseases most harmful to the Chinese elderly population. Although the brachiocephalic artery stenosis is rare, it is very harmful. This article describes the possibility and safety of brachiocephalic arterioplasty through a carotid artery. It also illustrates the feasibility of suturing the carotid puncture site with a suturing device. We hope that it will inspire our peers.