Endovascular stenting for atherosclerotic subclavian artery stenosis in patients with other craniocervical artery stenosis

Abstract

Atherosclerotic subclavian artery stenosis (SAS) accompanied with other craniocervical artery stenosis (OCAS) is not uncommon in practice. We sought to investigate the safety and efficacy of endovascular stenting for SAS in patients with OCAS. Between January 2004 and February 2012, 71 consecutive atherosclerotic SAS patients who underwent primary stenting in our medical center were included. The enrolled patients were divided into combined-SAS group (n = 51) and solitary-SAS group (n = 20) depending on the presence or absence of OCAS. Data of demographics, procedure, and the followed-up were retrieved and analyzed. The technical success rate was 95.8%; the clinical success rate was 90.1%. There was no catheter-related major stroke or death. The immediate outcomes had no statistical difference between groups. During a mean of 27 ± 20 months (range 2-88 months) followed-up, 7 (10.3%) restenosis and 12 (17.6%) clinical events were identified. The primary patency rate was 95.3, 84.9 and 84.9% at 12, 24 months, and final followed-up respectively, which had no statistical difference between groups (odds ratio (OR), 2.60; 95% confidence interval (CI), 0.54-12.53; P = 0.232). The overall clinical event-free survival rate was 93.5, 86.2 and 54.6%, respectively, where the result of combined-SAS group was inferior to that of the solitary-SAS group (OR, 3.34; 95% CI, 1.02-11.00; P = 0.047). Endovascular stenting was safe and feasible for atherosclerotic SAS in patients with OCAS, although the combined OCAS may have a significant influence on the long-term outcome. Further studies are warrant to investigate the effects of revascularization for multiple craniocervical artery stenoses on the cerebral hemodynamics and long-term outcomes.

Endovascular Treatment of Chronic Total Occlusion in the Subclavian Artery: A Review of 23 Cases

“…The long-term patency rate in our study was not different from the previously reported patency rate of atherosclerotic subclavian artery stenosis (13). Restenosis is a common adverse event of stent implantation.…”

Spontaneous Early Recanalization after Acute Innominate Artery Thromboembolic Occlusion Secondary to Abrupt Aspirin and Statin Discontinuation: A Case Report

“…Compared to SA lesions (which are primarily asymptomatic), IA lesions have a higher rate of clinical symptomatology. Lesions of the IA can present with variable symptoms including arm claudication, vertebrobasilar insufficiency and cerebrovascular accidents (3,4). Previous angiographic studies have demonstrated that IA atherosclerotic lesions account for only 2.5% of extracranial and intracranial arterial occlusive disease, but another Doppler ultrasound study has shown that the incidence of IA occlusive disease (accompanied by haemodynamic insufficiency) can be as rare as 0.06% (5,6).…”

“…Previous angiographic studies have demonstrated that IA atherosclerotic lesions account for only 2.5% of extracranial and intracranial arterial occlusive disease, but another Doppler ultrasound study has shown that the incidence of IA occlusive disease (accompanied by haemodynamic insufficiency) can be as rare as 0.06% (5,6). Diverse treatment alternatives are available for patients with acute symptomatic IA occlusion, including percutaneous transluminal angioplasty, intra-arterial thrombolytic therapy, or mechanical thrombectomy (3,4,7). However, early spontaneous recanalization of an extracranial arterial occlusion (especially an IA occlusion) has rarely been reported.…”

Endovascular treatment of subclavian artery stenosis

“…In many patients, who are having discrete symptoms, they tend to improve over time without treatment, because of the efficient collateralization and that is why surgical and interventional methods are not usually indicated for asymptomatic subclavian stenosis/occlusion. Even though medical therapy is advocated as the first line treatment, endovascular revascularization is emerging as an alternative [1][2][3]. Intervention is usually indicated for upper extremity ischemia, vertebro-basilar symptoms, subclavian steal syndrome, and coronary steal syndrome.…”

“…In symptomatic patients the most common surgical approach is the extra thoracic revascularization -carotid-subclavian bypass, or subclavian to carotid transposition. The preferred method of treatment for subclavian stenosis in the last years is endovascular, which is remarkable with low complication rate and a high success rate [3]. It includes angioplasty alone or followed by stent implantation.…”