Presentation, Diagnosis and Management of Innominate Artery Thromboembolism

Authors

Heepeel Chang, Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, NY, USA.
Caron B. Rockman, Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, USA.
Navneet Narula, Department of Pathology and Laboratory Medicine, New York University Langone Medical Center, New York, NY, USA.
Joshua K. Sabari, Department of Pathology and Laboratory Medicine, New York University Langone Medical Center, New York, NY, USA.
Karan Garg, Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, USA.

Author Type(s)

Faculty

Journal Title

Journal of Endovascular Therapy

First Page

451

Last Page

456

Document Type

Article

Publication Date

6-1-2022

Department

Surgery

Abstract

PURPOSE: Acute thromboembolic disease of the innominate artery (IA) poses a unique set of therapeutic challenges, owing to its contribution to both the cerebral and upper extremity circulation, and risks of distal embolization via the carotid and subclavian arteries, respectively. Herein, we present a 74-year-old female who presents with acute IA thrombus treated successfully with right axillary and common carotid exposure and aspiration catheter-directed mechanical thrombectomy (CDT). Furthermore, an emerging use of CDT and its application in acute thromboembolism are outlined. CASE REPORT: A 74-year-old female with history of right lung transplant for pulmonary fibrosis with severe pulmonary hypertension, and stage IIIA left lung adenocarcinoma status post left lower lobectomy undergoing adjuvant chemotherapy presented with acute IA thrombus and right-sided stroke. She was treated successfully with right axillary and common carotid exposure and aspiration CDT. Computed tomography angiography performed 1 month postoperatively confirmed patent IA with no evidence of residual or recurrent thrombus. CONCLUSION: There are currently no standard guidelines on the management of acute IA thromboembolism, with mostly individual cases reported in the literature describing this rare entity. Nevertheless, this unique clinical entity mandates expeditious diagnostic and therapeutic approaches in order to avoid permanent neurologic deficits from distal embolization. Our case demonstrates that aspiration CDT may be an effective treatment modality for patients with acute IA thrombus.

Recommended Citation

Chang, H., Rockman, C. B., Narula, N., Sabari, J. K., & Garg, K. (2022). Presentation, Diagnosis and Management of Innominate Artery Thromboembolism. Journal of Endovascular Therapy, 29 (3), 451-456. https://doi.org/10.1177/15266028211054765