Subclavian artery stenting with vertebral artery embolic protection via brachial approach complicated by transient cortical blindness

Vertebral protection is not routinely performed during subclavian artery stenting. The purpose of this article is to report a case of symptomatic ulcerative left subclavian stenosis, which was treated by subclavian stenting with cerebral protection achieved by positioning a filter device in the ipsilateral vertebral artery via the left brachial approach. Filter placement via brachial approach allowed successful cerebral protection while trespassing and stenting the ulcerative subclavian artery lesion. Although the retrieved filter had captured significant amount of debris with no ischemic lesions at diffusion weighted MR images at 6th hour and 3rd day of the procedure, the patient developed transient cortical blindness immediately after the procedure, which was recovered completely at 3rd day. Vertebral artery vasospasm or posterior system ischemia caused by the filter application may have played a role in this complication as well as the contrast material reaction that is generally described as related to posterior system diagnostic angiographies.