False Aneurysm after Balloon Dilation of a Calcified Innominate Artery Stenosis

Abstract

Purpose:

To describe the occurrence of a false aneurysm after percutaneous transluminal angioplasty of a severely calcified, high-grade stenosis of the brachiocephalic trunk.

Case Report:

A 68-year-old patient was admitted with cerebrovascular insufficiency, right upper extremity ischemia, and recurrent amaurosis fugax. Magnetic resonance arteriography (MRA) and duplex ultrasound revealed a severely calcified, high-grade stenosis of the innominate artery. Balloon dilation of this lesion was performed with minimal morphological success. After dilation, the patient suffered a reversible ischemic neurological deficit, from which he recovered completely. The patient's symptoms improved, but after 3 weeks he was re-admitted with palsy of the recurrent laryngeal nerve. An MRA showed a false aneurysm at the dilation site. Open surgery was performed, and the patient received a bifurcated aorto-subclavian-carotid bypass graft. He was discharged free of his preoperative symptoms.

Conclusions:

This case illustrates the potential hazards of angioplasty of severely calcified stenoses of the supra-aortic vessels.

Keywords

innominate artery stenosis calcification balloon angioplasty neurological complication subclavian steal bypass grafting

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