Subclavian artery stenosis has long been treated with great success with bypass surgery. Percutaneous intervention, often used in combination with stent placement, has come into vogue for the past few years as a safe and effective therapeutic modality. This study aimed to compare angioplasty alone with angioplasty followed by stent placement by combining available data. The objective of this study was to perform a review of the available literature to compare the efficacy of percutaneous transluminal angioplasty (PTA) alone with PTA followed by stent placement for proximal subclavian artery stenosis. Successful recanalization was defined as patency at the end of 1 year, and reocclusions and restenoses were noted as events for the purpose of pooling the data. The authors searched the Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, PubMed, EMBASE, and CINAHL databases for relevant trials/studies comparing PTA and PTA with stenting. Review authors independently assessed the methodological quality of studies (focusing on the adequacy of the randomization process, allocation concealment, blinding, completeness of follow-up, and intention-to-treat analysis) and selected studies for inclusion. All retrospective observational studies were also included in the analysis in the absence of double-blinded randomized trials for increasing sample size. All analyses were done using RevMan 5.0. Odds ratio was calculated using Mantel-Haenszel test with a fixed effect model. All included studies were assessed by all authors for potential sources of bias. Eight studies were included in the analysis having 544 participants. Stenting after PTA was significantly superior to angioplasty alone for treatment of subclavian artery stenosis and maintenance of patency at 1 year, as indicated by absence of events (P = 0.004; 95% confidence interval, odds ratio 2.37 [1.32-4.26]) without significant complication rates for either procedure. There is evidence in favor of stent placement after angioplasty for successful recanalization of stenosed subclavian arteries and long-term maintenance of patency without significant increase in risk for major complications in subjects.

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A n 82-year-old woman presented with shortness of breath. Examination revealed a holosystolic murmur in the mitral region. Echocardiography showed cor triatriatum (A and B, Online Videos 1 and 2) and mitral valve prolapse with significant mitral regurgitation (Online Videos 3 and 4). Coronary artery bypass grafting, mitral valve replacement, and excision of left atrial membrane were performed. A 79-year-old woman presented with expressive aphasia. Imaging of the brain did not reveal any acute intracranial disease. Echocardiography revealed cor triatriatum (C and D, Online Videos 5 and 6). Membrane was nonobstructive with no flow disturbance (Online Videos 7 and 8). A diagnosis of transient ischemic attack was made. In cor triatriatum sinister, the left atrium is divided into 2 chambers by a fibromuscular membrane (i.e., the posterosuperior chamber receives blood from the pulmonary veins and anteroinferior chamber, which behaves as the true left atrium). The fenestration area of the membrane does not change with age, and the late presentation is due to the development of complications such as mitral regurgitation and atrial fibrillation.

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