Journal of Vascular Surgery Cases and Innovative Techniques (Oct 2024)

A technique for prevention of posterior stroke during urgent revascularization of an acutely ischemic left upper extremity

  • Lauren M. Heyda, MD,
  • Kai Hata, MD,
  • Erin Koelling, MD,
  • Brandon Propper, MD,
  • Jonathan Jay Sexton, MD

Journal volume & issue
Vol. 10, no. 5
p. 101559

Abstract

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Upper extremity acute limb ischemia (ALI) owing to obstruction proximal to the vertebral artery poses the risk of posterior stroke during intervention. We describe a case of upper extremity ALI secondary to thrombosis of the proximal left subclavian artery with thromboembolic occlusion at the brachial bifurcation. The patient underwent a hybrid procedure of open thromboembolectomy with endovascular vertebral artery embolic protection. The patient's distal pulses and upper extremity function returned to baseline, without evidence of posterior stroke. A literature review revealed limited reports of the use of cerebral embolic protection in the setting of emergent thromboembolectomy for upper extremity ALI.

Keywords