A technique for prevention of posterior stroke during urgent revascularization of an acutely ischemic left upper extremity

Upper extremity acute limb ischemia (ALI) owing to obstruction proximal to the vertebral artery poses the risk of posterior stroke during intervention. We describe a case of upper extremity ALI secondary to thrombosis of the proximal left subclavian artery with thromboembolic occlusion at the brachial bifurcation. The patient underwent a hybrid procedure of open thromboembolectomy with endovascular vertebral artery embolic protection. The patient's distal pulses and upper extremity function returned to baseline, without evidence of posterior stroke. A literature review revealed limited reports of the use of cerebral embolic protection in the setting of emergent thromboembolectomy for upper extremity ALI.