Dual-guidewire technique with cerebral embolic protection for brachiocephalic trunk bifurcation stenosis: a case report
4 affiliations
- 1Department of Neonatology, Luzhou People's Hospital
- 2Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University
- 3Department of Neurosurgery, Luzhou Naxi District People's Hospital
- 4Department of Cerebrovascular Disease, Luzhou People's Hospital
Abstract
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.
Related
- Surgical Technique – The “Derriere View” for Evaluation of Guidewire Position in Cephalomedullary Nailing of Intertrochanteric Femur Fractures
- Efficacy and safety of flow diverters for middle cerebral artery bifurcation aneurysms: a retrospective dual-center study
- Planned Impella 5.5 Support via Brachiocephalic Artery or Ascending Aorta for Low Ejection Fraction, High-Risk Cardiac Surgery
- Anomalous Left Brachiocephalic Vein Draining into the Right Internal Thoracic Vein: A Case Report.
- Retained Guidewire Following Perforator Vein Ablation
BibTeX
@article{gan2026dualguidewire,
title = {{Dual-guidewire technique with cerebral embolic protection for brachiocephalic trunk bifurcation stenosis: a case report}},
author = {Yulan Gan and Guoyin Pang and Guofei Zhang and Jun Yang and Wenyou Wu and Zhifu Song},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1955380},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1955380/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Dual-guidewire technique with cerebral embolic protection for brachiocephalic trunk bifurcation stenosis: a case report
AU - Yulan Gan
AU - Guoyin Pang
AU - Guofei Zhang
AU - Jun Yang
AU - Wenyou Wu
AU - Zhifu Song
PY - 2026
DA - 2026/10/08
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1955380
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1955380/full
AB - 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.
SN - 2297-055X
ER -