Hybrid Retrograde Stenting for Symptomatic Innominate Artery Stenosis

2026-04-12T16:08:40+00:00

Innominate (brachiocephalic) artery stenosis is a rare but important cause of cerebrovascular events, accounting for <2% of extracranial cerebrovascular disease. Clinical presentations include transient ischemic attacks (TIAs), cerebrovascular accidents (CVA), and upper extremity ischemia. Diagnosis is frequently delayed due to symptomatic overlap with carotid and intracranial pathology. Endovascular stenting is increasingly favored over open bypass, although reported experience remains limited compared with open revascularization. In addition, the optimal site access and embolic protection strategy remain topics of debate. The presented case involves a 64-year-old woman who developed recurrent transient left hemibody weakness. Carotid artery evaluation including Computed Tomographic Angiography (CTA) and duplex ultrasound, revealed no significant stenosis within the carotid vessels. Subsequent review of CTA of the head and neck demonstrated severe calcific plaque throughout the brachiocephalic artery with filling defects suggestive of adherent thrombus. The patient was started on apixaban by cardiology as an outpatient. Despite therapy, her symptoms progressed, prompting emergency department referral for TIA evaluation. The patient underwent a hybrid retrograde innominate artery stenting via surgical right common carotid artery (RCCA) access. This case highlights the importance of considering proximal great vessel disease in patients with unexplained cerebrovascular symptoms and the diagnostic and therapeutic challenges posed by innominate artery disease.

Pyoderma Gangrenosum As Early Manifestation of Dermatomyositis

2026-06-09T13:30:58+00:00

An elderly female in her 60s with multiple comorbidities presented with chronic lower limb ulcers. After a skin biopsy, the patient was diagnosed with pyoderma gangrenosum, and immunosuppressive therapy was initiated; however, the lesions remained refractory. Ten years later, she developed seronegative rheumatoid arthritis and was started on methotrexate, corticosteroids, and later adalimumab, resulting in partial improvement. In 2025, the patient developed proximal muscle weakness along with multiple other systemic manifestations. Following extensive laboratory and imaging investigations, a diagnosis of dermatomyositis was finally established.

This case represents an unusual presentation and a challenging diagnosis of Dermatomyositis.

Journal of Medical Case Reports and Reviews

Hybrid Retrograde Stenting for Symptomatic Innominate Artery Stenosis

Pyoderma Gangrenosum As Early Manifestation of Dermatomyositis