Endovascular Repair of Symptomatic Coronary–Subclavian Steal Syndrome due to Stenosis of the Proximal Left Subclavian Artery

Tortoledo, Francisco; Sánchez, Alejandro; Izaguirre, Leonardo; Guerrero, Julio; Trujillo, Máximo H.

doi:10.1097/01.crd.0000148161.80868.bd

Cited by 3 publications

(3 citation statements)

References 4 publications

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“… 2) 5) The treatment for CSS was thoracotomy with aortosubclavian bypass, carotid subclavian bypass graft, and, more recently, angioplasty and stenting. 10) 13) Endovascular treatment in CSS due to SA stenosis after CABG has already been reported, and endovascular therapy with PTA and stenting appeared to be an effective treatment for CSS due to SA stenosis. 2) 6) 10) 13) 14) On the other hand, cardiac and cerebral protection during SA stenting in CSS was not performed.…”

Section: Discussionmentioning

confidence: 99%

“… 10) 13) Endovascular treatment in CSS due to SA stenosis after CABG has already been reported, and endovascular therapy with PTA and stenting appeared to be an effective treatment for CSS due to SA stenosis. 2) 6) 10) 13) 14) On the other hand, cardiac and cerebral protection during SA stenting in CSS was not performed. 2) 6) 10) 13) 14) Although native coronary stent angioplasty is performed with no distal embolic protection, the cardiac complication rate during SA angioplasty in CSS is unknown.…”

Section: Discussionmentioning

confidence: 99%

“… 2) 6) 10) 13) 14) On the other hand, cardiac and cerebral protection during SA stenting in CSS was not performed. 2) 6) 10) 13) 14) Although native coronary stent angioplasty is performed with no distal embolic protection, the cardiac complication rate during SA angioplasty in CSS is unknown. On the other hand, the cerebral protection methods during stenting for stenosis of the right SA origin or IA proximal to the right SA origin have been reported.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular Stenting under Cardiac and Cerebral Protection for Subclavian Steal after Coronary Artery Bypass Grafting Due to Right Subclavian Artery Origin Stenosis

Sakamoto

Kiura

Okazaki

et al. 2015

J Cerebrovasc Endovasc Neurosurg

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Coronary-subclavian steal (CSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). Subclavian artery (SA) stenosis proximal to the ITA graft causes CSS. We describe a technique for cardiac and cerebral protection during endovascular stenting for CSS due to right SA origin stenosis after CABG. A 64-year-old man with a history of CABG using the right ITA presented with exertional right arm claudication. Angiogram showed a CSS and retrograde blood flow in the right vertebral artery (VA) due to severe stenosis of the right SA origin. Endovascular treatment of the right SA stenosis was planned. For cardiac and cerebral protection, distal balloon protection by inflating a 5.2-F occlusion balloon catheter in the SA proximal to the origin of the right VA and ITA through the right brachial artery approach and distal filter protection of the right internal carotid artery (ICA) through the left femoral artery (FA) approach were performed. Endovascular stenting for SA stenosis from the right FA approach was performed under cardiac and cerebral protection by filter-protection of the ICA and balloon-protection of the VA and ITA. Successful treatment of SA severe stenosis was achieved with no complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endovascular Stenting under Cardiac and Cerebral Protection for Subclavian Steal after Coronary Artery Bypass Grafting Due to Right Subclavian Artery Origin Stenosis

Sakamoto

Kiura

Okazaki

et al. 2015

J Cerebrovasc Endovasc Neurosurg

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Endovascular Recanalization of the Chronically Occluded Brachiocephalic and Subclavian Arteries: Technical Considerations and an Argument for Embolic Protection

et al. 2013

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Cerebral Ischemic Complications of Subclavian Artery Stenting: Relationship between Lesion Location and Procedural Strategy

Arihara

Miyata

Iihoshi

et al. 2019

JNET

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Clinical research demonstrating safety and security in subclavian artery stenting (SAS) is limited because treatment strategies for SAS vary greatly among institutions, operators, and clinical conditions, as no standard protocol exists. As stenotic lesions frequently occur in the proximal portion of the subclavian artery (SA), it is often difficult to stabilize the guiding catheter for stent delivery. Our purpose was to assess whether lesion location can be used to predict optimal procedural strategies. Methods: We performed a retrospective, single-center observational study on 26 consecutive patients who underwent SAS between 2004 and 2016. We categorized patients treated with SAS into two groups according to lesion location: those with lesions located less than 10 mm from the origin of the SA (Group P) and those with lesions in the distal portion (Group D). We defined a bidirectional approach via both brachial and femoral puncture as well as bilateral brachial puncture as combined access. In pull-through method, a guidewire was passed from one sheath to another. We compared Group P with Group D in terms of procedural strategy and efficacy. Results: All 26 cases were clinically successful. Asymptomatic cerebral embolism was found in 10 (48%) of 21 cases in which postoperative MRI was performed, and the number of spotty lesions was less than four in every patient. Arterial access-site complications were documented in eight patients. Two cases of late in-stent restenosis were retreated with balloon dilatation. Cases with retrograde ipsilateral vertebral artery (VA) blood flow and symptomatic lesions occurred more frequently in Group P than in Group D (79% vs. 42%; p = 0.06, 71% vs. 33%; p = 0.05, respectively). Patients in Group P were significantly more often treated with combined access (100% vs. 42%; p = 0.001), with the pull-through method (64% vs. 0%; p < 0.001) than those in Group D. The distal end of the stent was involved with the ipsilateral VA orifice more often in Group D than in Group P (50% vs. 7%; p = 0.02). Conclusion: These results demonstrate that our strategy is a safe and effective method of stenting for SA stenosis in the portion of the artery that is proximal to the aorta. We should pay special attention to the risk of arterial access-site complications. Keywords▶ subclavian artery occlusive disease, stenting, endovascular therapy, cerebral embolism This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Endovascular Repair of Symptomatic Coronary–Subclavian Steal Syndrome due to Stenosis of the Proximal Left Subclavian Artery

Cited by 3 publications

References 4 publications

Endovascular Stenting under Cardiac and Cerebral Protection for Subclavian Steal after Coronary Artery Bypass Grafting Due to Right Subclavian Artery Origin Stenosis

Endovascular Stenting under Cardiac and Cerebral Protection for Subclavian Steal after Coronary Artery Bypass Grafting Due to Right Subclavian Artery Origin Stenosis

Endovascular Recanalization of the Chronically Occluded Brachiocephalic and Subclavian Arteries: Technical Considerations and an Argument for Embolic Protection

Cerebral Ischemic Complications of Subclavian Artery Stenting: Relationship between Lesion Location and Procedural Strategy

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