PC072. Innominate Artery Revascularization: Long-term Outcomes and Comparison of Open and Endovascular Approach

Abstract

Atherosclerotic disease of the innominate artery (IA) is rare and can lead to cerebral and upper extremity ischemia symptoms. Nonocclusive lesions can be treated with endovascular interventions, often with a hybrid approach while performing a right carotid endarterectomy (RCEA). Occlusive lesions usually require treatment through a median sternotomy and bypass. The purpose of our study was to review the short- and long-term outcomes of IA revascularization in our institution. Our section’s operative database was used to identify patients who underwent IA revascularization between January 1998 and December 2018. Patients who underwent IA stenting (IAS), combined RCEA and IAS, and aorta-innominate bypass (AIB) were collected. Our primary end points were freedom from neurologic event, all-cause mortality, and need for reintervention. Thirty-three patients (18 female [55%]) who underwent IA revascularization were identified. Average age was 67 ± 8 years, and mean clinical follow-up was 51 ± 21 months. Most patients (30 [91%]) were taking a statin and antiplatelet therapy. Twenty-one patients (64%) were symptomatic. Twelve patients (36%) were asymptomatic and underwent combined RCEA with retrograde IAS for critical right carotid stenosis and IA stenosis. Preoperative imaging included carotid duplex ultrasound and computed tomography angiography. Eighteen patients (55%) underwent RCEA and IAS, 11 patients (33%) underwent IAS in a retrograde approach through right carotid exposure, and 4 patients (12%) underwent AIB. Patients who underwent AIB had chronic IA occlusions with failed endovascular interventions. All patients were followed up with carotid duplex ultrasound intraoperatively and at 1-month and 6-month intervals after the procedure. Perioperative stroke rate of 3% involved one patient who developed reperfusion syndrome after RCEA and IAS. Perioperative mortality was 0%. Long-term stroke rate was 0%, and long-term mortality was 15% (5/33) due to cardiac disease (Fig 1). Overall restenosis rate was 9% involving three patients who required secondary interventions for IA in-stent restenosis (Fig 2). IA interventions through a hybrid or open approach are safe with acceptable perioperative stroke and mortality rates. Long-term durability of these interventions seems acceptable. Patients undergoing IAS appear to have a higher rate of restenosis compared with AIB; therefore, close follow-up with noninvasive imaging is recommended.Fig 2Innominate artery (IA) interventions. IAS, Innominate artery stenting; R CEA, right carotid endarterectomy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)