Key result
Dual-guidewire rail stenting with cerebral protection successfully resolves severe brachiocephalic bifurcation stenosis with durable relief.
Why the study?
Severe stenosis at the terminal bifurcation of the brachiocephalic trunk is a rare and challenging lesion where endovascular intervention carries a high risk of embolization and difficulty in delivering large-diameter stents.
Case Report (n=1)
No
Demonstrates the feasibility of a simplified single-femoral-access, single-ICA-filter, and dual-guidewire rail strategy to safely deliver a large-diameter stent in severe brachiocephalic trunk bifurcation stenosis with protective retrograde vertebral flow.
Answers are grounded in this paper and cite their sources.
Should not yet change practice for brachiocephalic trunk stenosis; leaves open the role of dual-guidewire rail technique with single-filter protection.
Background: Severe stenosis at the terminal bifurcation of the brachiocephalic trunk involving the origins of the right common carotid artery and the right subclavian artery is a rare and highly challenging lesion of the supra-aortic vessels. Endovascular intervention carries a high risk of embolization and difficulty in delivering large-diameter stents. Case summary: We report a 60-year-old male patient who presented with intermittent dizziness and asymmetric blood pressure in the upper limbs. Color Doppler ultrasound and head and neck CT angiography revealed severe stenosis at the terminal bifurcation of the brachiocephalic trunk (stenosis rate approximately 90%), with the lesion involving the origins of the right common carotid artery and the right subclavian artery, accompanied by right subclavian artery steal phenomenon. The patient underwent brachiocephalic trunk balloon angioplasty and stenting via a single femoral artery access. An embolic protection device was deployed in the C1 segment of the right internal carotid artery for distal cerebral protection. During delivery of the stent, the filter guidewire provided insufficient support; a second guidewire was added as a buddy wire to establish a dual-guidewire rail technique, facilitating successful stent placement. Debris was observed in the retrieved filter. Postoperatively, the severe stenosis was relieved and the steal phenomenon resolved. At 1.5 years of follow-up, the patient reported no recurrence of dizziness, and the inter-arm blood pressure difference remained within the normal range. Conclusion: In this selected case with clear antegrade flow direction, a single-access, single-filter strategy appeared feasible and may offer a simplified alternative for similar anatomical presentations. However, further validation in larger case series is warranted. The application of dual-guidewire rail technique to overcome difficulties in large-diameter stent delivery during brachiocephalic trunk intervention has been rarely reported.
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Gan et al. (2026) conducted a case report in Severe stenosis at the terminal bifurcation of the brachiocephalic trunk (~90%) with right subclavian artery steal phenomenon (n=1). Brachiocephalic trunk balloon angioplasty and stenting via single femoral artery access using a single right internal carotid artery embolic protection filter and a dual-guidewire rail technique was evaluated on Angiographic resolution of stenosis and clinical symptom relief (dizziness and inter-arm blood pressure asymmetry). Dual-guidewire rail stenting with single-filter cerebral protection resolved a 90% brachiocephalic trunk bifurcation stenosis and kept the patient symptom-free at 1.5 years.
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