Angioplasty Alone Versus Angioplasty and Stenting for Subclavian Artery Stenosis—A Systematic Review and Meta-analysis

Abstract

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.

Successful treatment of total occluded innominate artery in a patient with subclavian steal syndrome

“…The results of the largest series suggested stenting as the treatment of choice in selected patients (4). In addition, Chatterjee et al (5) showed that stenting is significantly superior to angioplasty alone. We chose endovascular stenting approach for this patient.…”

Kissing Balloon Angioplasty for Subclavian Artery Combined with Vertebral Artery Origin Stenosis

“…Subclavian artery stenosis was usually treated by surgical bypass surgery.In recent years, with the progress of interventional therapy equipment and technology, more and more patients have obtained satisfactory curative effect through interventional therapy.Interventional therapy mainly includes simple balloon dilatation and stent placement. Systematic reviews comparing the two treatments have shown that both have lower complication rates, and stent placement can better maintain the patency of blood vessels compared with simple balloon dilatation [1], but http://www.ijSciences.com Volume 9 -October 2020 (10)…”

Resolution of ischemic symptoms after percutaneous angioplasty for a symptomatic subclavian artery stenosis

“…[6][7][8] Patients with symptomatic SAS should undergo revascularization, preferably with percutaneous transluminal angioplasty (PTA) as the first choice strategy. [9][10][11][12] This procedure has a low complication rate and a durable effect. [10][11][12] However, the impact of the PTA on specific SAS-related symptoms has not been evaluated in detail so far.…”

“…[9][10][11][12] This procedure has a low complication rate and a durable effect. [10][11][12] However, the impact of the PTA on specific SAS-related symptoms has not been evaluated in detail so far.…”