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

Abstract

Objectives and Background: To review technical details and long-term outcomes of endovascular treatment of chronic total occlusion (CTO) of the subclavian artery. Methods: From January 2010 to May 2017, 23 patients (17 male; median age, 65 years) underwent endovascular treatment for CTO of the subclavian artery. All lesions had been diagnosed by duplex scanning or computed tomography angiography before treatment. Sixteen (70.0%) patients had symptoms of vertebrobasilar insufficiency, 6 (26.1%) patients had symptoms of arm ischemia, and 2 (8.7%) patients were asymptomatic. Duplex scanning revealed that 16 patients had grade 3 and 7 patients had grade 2 steal blood flow. After recanalization, lesions were treated by stenting. Patients were followed up at 1, 3, 6, and 12 months after endovascular treatment, and annually thereafter. Results: The overall technical success rate was 91.3% (21/23). The successful recanalization rate of antegrade and retrograde approaches were 68.2% (15/22) and 75.0% (6/8), respectively. The rate of clinical symptom remission was 95.2% (20/21) after treatment. No perioperative death or permanent neurological deficits were observed. One patient had arterial dissection treated by covered stent. The estimate cumulative primary and secondary patency rates at 5 years were 74.6 and 78.8%, respectively. Conclusion: Endovascular treatment is a feasible and safe treatment for CTO lesions of the subclavian artery.

Utility of CT Perfusion Imaging in Patients With Vertebral Artery Stenosis Treated With Balloon Expandable Stent

“…In clinic, vertebrobasilar artery stenosis was a common disease leading to recurrent PC strokes, the main treatment for this disease was stent implantation. At present, the indications of stenting for vertebral artery stenosis are usually determined by whether the degree of stenosis is more than 50% which is detected by CTA or DSA examination before operation, and corresponding clinical symptoms such as dizziness, walking unsteadily, or the other symptoms ( 10 – 13 ). However, there was no objective assessment of the blood flow in the posterior circulation.…”

Clinic furniture arrangements leading to patient self-reported blood pressure discrepancy: a rare case of total occlusion of left subclavian artery

“…Males are more commonly affected than females and 75% of subclavian occlusion occur in the left artery (Shadman et al, 2004). Only 8.7% of patients with total occlusion of subclavian artery are asymptomatic while 70.0% patients have symptoms of vertebrobasilar insufficiency, and 26.1% patients have symptoms of arm ischemia (Niu et al, 2020). The most common symptoms of subclavian artery occlusion are arm claudication or muscle fatigue, rest pain, and in severe cases, digital ischemia.…”

Identifying the occlusion of left subclavian artery with stent based on chest MRI images

“…When blood is insufficiently supplied to the ipsilateral vertebral artery, the patient may have the following symptoms: lightheadedness, confusion, dizziness, motor deficits, visual disturbances, focal seizures, vertigo, and ataxia. Subclavian artery stenosis may cause upper-extremity claudication and fatigue, even incite angina pectoris due to coronary artery steal with retrograde blood flow occurring when performing an upper-extremity exercise [31]. Common symptoms of subclavian artery stenosis are bruits over the subclavian artery, blood pressure decrease, and intermittent claudication of the arm on the same side as the subclavian artery.…”

“…The clusters also achieved the validation of clinical results. In [31], a semi-automated software based on plaque characterization was employed to predict subsequent cardiac death during long-term follow-up. M. Zreik et al [48] integrated convolutional neural network [16], unsupervised convolutional autoencoder [37], and SVM [11] to identify the patients with a functionally significant coronary artery stenosis.…”

“…The thrombosis incidence of the left subclavian artery is four times higher than that of the right subclavian artery. It will cause severe ischemia in the brain, upper extremities, and occasionally the heart [31]. However, there is no good way to predict restenosis of left subclavian arteries after stenting.…”