ABSTRACT
Brachiocephalic interventions are being performed with increasing frequency. Endovascular approaches have replaced open surgery for most cases of common carotid and subclavian diseases. Assessment of the arch, therefore, is an important part of patient assessment and procedural planning. Preoperative assessment is best performed using omputed tomography angiography. Lesions of the innominate and common carotid arteries that require treatment occur less frequently than carotid bifurcation stenoses. Lesions at the origin of the innominate, common carotid, and subclavian arteries are treated with balloon-expandable stents for accuracy of placement and crush resistance appropriate for highly calcified lesions. Carotid bifurcation stenting may be performed using a transfemoral or a transcervical exposure, with a small number of patients being best served by an approach through the brachial or radial arteries. Both open cell stents and closed cell stents are available for treatment of carotid bifurcation stenosis. Subclavian and axillary artery lesions can be approached antegrade or retrograde.
