"Washout" technique for brachiocephalic angioplasty

Percutaneous transluminal angioplasty (PTA) of the brachiocephalic arteries has been described for treatment of symptoms secondary to fibromuscular dysplasia [1 ], subclavian steal syndrome [2], and postoperative stenosis [3]. The technique has been used to a much lesser extent in the treatment of atherosclerotic disease, either as the primary modality [48] or in combination with a carotid endarterectomy [9]. Reluctance to use PTA for atherosclerotic disease is related to the morbidity associated with distal embolization into the cerebral circulation. We report a case of PTA of atherosclerotic narrowing of the right innominate and common carotid artery done in conjunction with a common carotid arteriotomy and a “washout” of angioplasty debris.