Brachiocephalic and subclavian stenosis: Current concepts for cardiovascular specialists

Patel, Rajan A.G.; White, Christopher J.

doi:10.1016/j.pcad.2021.03.004

Cited by 9 publications

(6 citation statements)

References 25 publications

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“…There was no risk of subclavian stenting causing distal dispersal of a carotid artery thrombus. The advantage of subclavian artery stenting is its high technical success rate of 95–100% and low periprocedural stroke rate of 0.8% [ 7 , 16 ]. However, the restenosis rate of subclavian artery stenting is reported as 12–18.7%, which is slightly higher than that of CAS [ 16 – 20 ], and the indication for carotid artery revascularization is generally clear [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…1b, c). We determined that typical subclavian artery stenting, known to have a high procedural success rate [ 7 , 8 ], is safer than direct carotid endovascular intervention, which is not well-visualized and has multiple underlying pathologies. This finding prompted us to perform left subclavian artery stenting as a safe palliative procedure.…”

Section: Case Presentationmentioning

confidence: 99%

“…Subclavian artery stenosis is a rare peripheral arterial disease, with an overall prevalence of 1.5%; however, the prevalence is reported to be as high as 11–40% in patients with comorbid risk factors for atherosclerosis [ 7 ]. Typically, this stenosis occurs on the proximal side of the affected subclavian artery, wherein blood flow in the ipsilateral vertebral artery is reduced and even reversed to direct cerebral blood flow to the ipsilateral arm.…”

Section: Introductionmentioning

confidence: 99%

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Stenting for subclavian steal phenomenon to restore cerebral perfusion due to acute carotid occlusion following carotid endarterectomy: a case report

Hirota,

Yoshimura,

Cho

et al. 2024

J Med Case Reports

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Background Perioperative symptomatic carotid artery occlusion after carotid endarterectomy is a rare complication. In this study, we present a case of symptomatic acute carotid artery occlusion that occurred after carotid endarterectomy in a patient with coexistent subclavian artery steal phenomenon, which was successfully treated with subclavian artery stenting. Case presentation A 57-year-old East Asian female presented with stenosis in the left common carotid artery and left subclavian artery along with subclavian steal. The proximal segment of the left anterior cerebral artery was hypoplastic, and the posterior communicating arteries on both sides were well-developed. Left internal carotid artery stenosis progressed during the follow-up examination; therefore, left carotid endarterectomy was performed. On the following day, symptoms of cerebral perfusion deficiency appeared due to occlusion of the left carotid artery. The stenotic origin of the left common carotid artery and the suspected massive thrombus in the left carotid artery posed challenges to carotid revascularization. Therefore, left subclavian artery stenting for the subclavian steal phenomenon was determined to be the best option for restoring cerebral blood flow to the whole brain. Her symptoms improved after the procedure, and the postprocedural workup revealed improved cerebral blood flow. Conclusion Subclavian artery stenting is safe and may be helpful in patients with cerebral perfusion deficiency caused by intractable acute carotid occlusion coexisting with the subclavian steal phenomenon. Revascularization of asymptomatic subclavian artery stenosis is generally not recommended. However, cerebral circulatory insufficiency as a comorbidity may be worth considering.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Stenting for subclavian steal phenomenon to restore cerebral perfusion due to acute carotid occlusion following carotid endarterectomy: a case report

Hirota,

Yoshimura,

Cho

et al. 2024

J Med Case Reports

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“…When a patient with aRSA undergoes the TAR+FET procedure, the frozen trunk deployed into the descending aorta will cover the oral of the aRSA, thereby blocking its blood flow. It emerges with a high possibility of neurological complications, such as paraplegia or dysfunction of the right upper limb caused by ischemia Patel 2021;Khoury 2021]. Therefore, revascularization of aRSA is necessary to avoid postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Fenestration of Frozen Elephant Trunk (FET) and Total Arch Replacement for Aortic Dissection in Aberrant Subclavian Artery

Zhang

Kang

Fei

et al. 2022

HSF

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Background: Total arch replacement (TAR) and the frozen elephant trunk (FET) routinely are performed to treat aortic dissection. When aortic dissection combines with the aberrant right subclavian artery (aRSA), routine TAR+FET will occlude the ostium of aRSA. But there is no consensus regarding the optimal surgical strategy to revascularize the aRSA. We seek an uncomplicated and less time-intensive way to reconstruct the aRSA. Methods: From July 2020 to April 2022, six patients with aortic dissection and aRSA underwent TAR+FET and intraoperative fenestration on the descending trunk. The mean age of the patients was 51.7 (SD 16.2; range 30.0–72.0). TAR+FET was performed via a median sternotomy and under cardiopulmonary bypass (CPB) and moderate hypothermic circulatory arrest (HCA). A fenestra of descending trunk was made intraoperative. Results: There was no operative death in hospital and follow up. The average aortic cross-clamp time, SACP time, and lower body circulatory arrest time was 138.8 (SD 22.5; range 103.0–156.0) min and 28.3 (SD 3.9; range 25.0–35.0) min. Bleeding, neurological deficit, visceral ischemia, injury to the spinal cord, or organ dysfunction was not observed. Follow-up CTA showed the blood flow of aRSA was patent in all patients. Conclusion: TAR+FET and intraoperative fenestration on the descending trunk is an efficacious approach. It also reduces the difficulty of reconstruction the aRSA in aortic dissection patients.

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“…The steal syndrome resulting from flow disorders in the brachiocephalic trunk is a relatively rare type of this type of pathology. Most often, the steal syndrome affects the left subclavian artery and results from the narrowing of its proximal part [ 2 ]. In the articles published so far there are few case reports of the brachiocephalic steal syndrome [ 3 , 4 , 5 , 6 ].…”

mentioning

confidence: 99%

Significant Stenosis of the Brachiocephalic Trunk and Moderate Stenosis of the Left Circumflex Artery in Computed Tomography Angiography Images

Gać

Poręba

2022

Diagnostics

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Atherosclerosis, as a civilization disease, is a serious epidemiological problem. Significant carotid disease and significant coronary artery disease result in acute consequences, such as ischemic stroke and myocardial infarction, which are the major causes of cardiovascular mortality. Typically, atherosclerosis of the aortic arch branches involves the bulbs of the common carotid arteries and the proximal segments of the internal carotid arteries, and can be effectively assessed by ultrasonography. Computed tomography angiography enables the identification of patients with less typical clinical manifestations of atherosclerosis, e.g., brachiocephalic trunk stenosis with symptoms of the steal syndrome and moderate stenosis in the coronary arteries. We present examples of computed tomography angiography images of this type of changes.

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Brachiocephalic and subclavian stenosis: Current concepts for cardiovascular specialists

Cited by 9 publications

References 25 publications

Stenting for subclavian steal phenomenon to restore cerebral perfusion due to acute carotid occlusion following carotid endarterectomy: a case report

Stenting for subclavian steal phenomenon to restore cerebral perfusion due to acute carotid occlusion following carotid endarterectomy: a case report

Intraoperative Fenestration of Frozen Elephant Trunk (FET) and Total Arch Replacement for Aortic Dissection in Aberrant Subclavian Artery

Significant Stenosis of the Brachiocephalic Trunk and Moderate Stenosis of the Left Circumflex Artery in Computed Tomography Angiography Images

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