Atheroma of the Innominate Artery Presenting as a Transient Ischemic Attack

• Published in: Curēus (Palo Alto, CA) Vol. 11; no. 1; p. e3961
• Main Authors: Hassan, Moin, Mubarik, Ateeq, Patel, Chirag, Haq, Furqan, Muddassir, Salman
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 25.01.2019; Cureus
• Subjects: Aspirin; Atherosclerosis; Cardiology; Carotid arteries; Case reports; Diabetes; Internal Medicine; Ischemia; Medical imaging; Morbidity; Mortality; Neurology; NMR; Nuclear magnetic resonance; Patients; Stroke; Tomography; Ultrasonic imaging; Veins & arteries; United States > US; neuroprotective device; transient ischemic attack; innominate artery atheroma; innominate artery stenting; supra aortic atherosclerotic lesions; innominate artery atheroma anticoagulation
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.3961

Supra-aortic atherosclerotic lesions, including innominate artery atheromas, are an uncommon but established cause of transient ischemic attacks, stroke, upper extremity ischemia, and vertebrobasilar insufficiency. We present a patient with a transient ischemic attack admitted with right hemispheric symptoms who was found to have a severe ulcerated innominate artery atheroma. The patient underwent an aortic arch angiogram with stenting of the innominate artery. The proper diagnosis, treatment, and management of innominate artery atheromas are imperative to prevent further cardiovascular morbidity and mortality in patients. Currently, both endovascular and surgical options are available for revascularization, and there have been no randomized controlled trials comparing endovascular versus open repair to standardize one as the standard of care over the other. No randomized controlled trials are examining the benefit of dual versus single antiplatelet therapy post-stenting in supra-aortic atherosclerotic lesions. We believe that this topic warrants further research and needs evidence-based guidelines to help direct physicians about treatment and management.