PMC5405376_01
(a) A sagittal plane of the CT angiography shows critical stenosis of innominate and left carotid artery emerging from a bovine arch (red arrow). (b) In the axial plane, a vulnerable plaque includes the common trunk and the origin of the innominate and left common carotid artery (yellow arrows).
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A contrast-enhanced multidetector computed tomography angiography (MDCTA) confirmed the lesion in the right carotid bifurcation and showed a proximal critical stenosis of the innominate and left carotid artery emerging from a BAA with a concentric vulnerable plaque of the bovine common trunk (Figure 1).
(a) Baseline angiogram of severe stenosis of the innominate and left common carotid arteries. (b) Omnilink stents across both vessels advanced over both wires in the common carotid arteries. (c) Final angiogram after stenting with antegrade flow in both vessels.
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After blood pressure was pharmacologically increased, a conventional simultaneous 8 x 29 mm balloon expandable kissing stenting (Omnilink Elite , Abbott Vascular, Inc.) was performed at the origin of the right and left common carotid artery during a transient bilateral ICA looping to flush debris in the external carotid artery (Figure 2).
3-month CT angiogram demonstrates excellent dilatation of the innominate (yellow arrow) and left common carotid artery (red arrow) in the supra-aortic portion.
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Follow-up at 3 months after device placement, including neurological observation, and MDCTA, demonstrated no complications, with patency of both proximal and distal treated lesions (Figure 3).