Introduction Supraaortic artery disease is recognized as the primary contributor to stroke incidents across the globe with majority of cases involving proximal internal carotid artery, as well as left subclavian artery and right proximal common carotid artery (CCA) focal stenosis in supraaortic vessel origin group. A woman in her late seventies presented with a sudden episode of unilateral visual impairment in her right eye. Significant stenosing plaque at the innominate artery bifurcation, extending into both CAA and the right subclavian artery, was confirmed by computed tomography.

Treatment options Considering symptomatic presentation, treatment indications were straightforward. Open surgery is technically challenging and has a high complication risk due to patient comorbidities and age, while endovascular targeting only CCA stenosis can lead to occlusion of the right subclavian artery or inadvertent embolisation. Therefore, the patient was recommended endovascular simultaneous kissing stenting of the innominate artery bifurcation. Femoral and brachial approach was utilized. A secure sheath position was achieved in the right proximal CCA and innominate artery prior to positioning the balloon-mounted covered stents, succeeded by uncovering and deploying the grafts at the desired location. DSA confirmed reconstructed vessel lumen and proper stent wall apposition. The patient had no complications and was discharged the next day with a dual antiplatelet therapy regimen.

Conclusion Severe stenosis of the innominate artery bifurcation requires a complex treatment approach to preserve the orifices of the adjacent vessels. We have shown that endovascular kissing stenting using balloon-mounted grafts is a feasible treatment strategy in a selected patient population.

Disclosure of Interest Nothing to disclose