Key result
Brachiocephalic stenting resolves hand ischemia and restores digital perfusion in ostial stenosis misdiagnosed as Buerger disease.
Why the study?
Brachiocephalic artery stenosis is an uncommon cause of upper extremity ischemia and cerebrovascular insufficiency, and diagnosis may be delayed due to subtle clinical manifestations.
Case Report (n=1)
Isolated upper extremity digital ischemia in high-risk smokers can represent proximal great vessel disease such as critical brachiocephalic artery stenosis, which can be effectively treated with endovascular stenting.
Answers are grounded in this paper and cite their sources.
Prompts proximal great-vessel evaluation in unexplained digital ischemia; leaves open stenting efficacy without prospective data.
BACKGROUND: Brachiocephalic artery stenosis is an uncommon cause of upper extremity ischemia and cerebrovascular insufficiency. Diagnosis may be delayed because of subtle clinical manifestations, particularly in patients with established atherosclerotic risk factors. CASE PRESENTATION: A 73-year-old woman with diabetes, dyslipidemia, and active tobacco use presented with progressive bluish discoloration and pain of the right-hand digits. The primary care physician initially misattributed the presentation to Buerger disease. Angiography revealed critical ostial brachiocephalic artery stenosis, and prompt endovascular stenting showed improvement in digital perfusion and eventual resolution of symptoms. DISCUSSION: This case highlights the potential for isolated upper extremity digital ischemia to represent proximal great vessel disease, especially among high-risk smokers. Careful examination and imaging are important for avoiding a missed diagnosis. Smoking cessation remains essential for long-term protection. TAKE-HOME MESSAGE: Detailed examination and interarm blood pressure measurement should be routinely performed in patients with unexplained upper-extremity ischemia to identify potential proximal great-vessel disease.
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Jha et al. (2026) conducted a case report in Acute-on-chronic upper limb ischemia caused by critical ostial right brachiocephalic artery stenosis (n=1). Endovascular stenting was evaluated on Improvement in digital perfusion and resolution of ischemic symptoms. Endovascular stenting of critical ostial brachiocephalic artery stenosis improved digital perfusion and resolved right-hand ischemia in a 73-year-old woman initially misdiagnosed with Buerger disease.
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