It is well known that significant narrowing of the subclavian or innominate artery may cause cerebrovascular ischemic symptoms. We report a case of a 62-year-old man who was suffering from progressive cognitive impairment and was treated by perctaneous transluminal angioplasty (PTA). The patient had undergone aorto-bifemoral bypass, left femoropopliteal bypass, and right femoral artery endoarterectomy. On admission, he was alert, but had memory impairment, especially delayed recall. He complained of dizziness and dysesthesia on his right upper extremity which got worse on exertion. The right radial pulse was diminished and the right brachial blood pressure was lower about 40 mmHg than the left. Angiography demonstrated severe stenosis of the innominate artery near its origin, hypoplasty of the left horizontal anterior cerebral artery segment (Al), and dilation of the left external carotid artery. Left vertebral arteriography revealed retrograde flow of the right vertebral artery in the late arterial phase. Single photon emission computed tomography (SPECT) revealed marked reduction in cerebral blood flow to the left frontal lobe. The patient underwent PTA of the innominate artery with satisfactory results. Cognitive impairment improved remarkably after the angioplasty. The right radial pulse was quite palpable, and the bilateral brachial blood pressures were the same. The cerebral blood flow was increased in SPECT. Memory disturbance can be generated by stenosis of the innominate artery. PTA is one of the effective methods to reverse such cognitive impairment.
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