Feasibility and Safety of Distal and Proximal Combined Endovascular Approach with a Balloon-Guiding Catheter for Subclavian Artery Total Occlusion

Yamamoto, Taiki; Ohshima, Tomotaka; Ishikawa, Kojiro; Goto, Shunsaku; Tamari, Yosuke

doi:10.1016/j.wneu.2017.02.018

Cited by 10 publications

(8 citation statements)

References 12 publications

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“…Our case series along with those of Yamamoto, Nakamura, and Sadato (18,28,34) are the few to describe a combined antegrade and retrograde endovascular approach to SA SAPTA. Our paper will serve as a reminder to young endovascular surgeons of the effectiveness, safety, and feasibility of this technique for SA recanalization now using new compliant small dual lumen balloons.…”

Section: Discussionmentioning

confidence: 88%

“…Current guidelines recommend endovascular approach as the first line in patients with atherosclerotic lesion of the upper extremities (17). This is based on multiple studies that have shown the technical success rate of PTA to be high and similar to that of surgical treatment but also less invasive with a low rate of major complications (3)(4)(5)(6)(7)(8)(9)18). PTA for SA stenosis is performed widely as an alternative to surgery, and the technique was first described in the early 1980's in several small series of patients (19,20).…”

Section: Discussionmentioning

confidence: 99%

“…One of the protective techniques against distal embolisms described by Yamamoto et al is by using the non-compliant Optimo balloon catheter (Tokai Medical Products, Aichi, Japan) through the ipsilateral radial artery (18,28). In their case series, Yamamoto et al (18) placed the 6-French Optimo balloon catheter in the SA proximal to the origin of the VA after introducing it through an ipsilateral transradial access. They inflated the balloon around the catheter while performing antegrade angioplasty and stenting of the affected SA for distal emboli protection.…”

Section: Discussionmentioning

confidence: 99%

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Combined Transradial and Transfemoral Approach With Ostial Vertebral Balloon Protection for the Treatment of Patients With Subclavian Steal Syndrome

et al. 2020

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Background: Patients with an obstructive subclavian artery (SA) may exhibit symptoms of vertebrobasilar insufficiency known as subclavian steal syndrome (SSS). Endovascular treatment with stent assisted percutaneous transluminal angioplasty (SAPTA) demonstrates significantly lower percentage of intraoperative and postoperative complications in comparison with open surgery. There is a 1-5% risk of distal intracranial embolization through the ipsilateral vertebral artery (VA) during SAPTA. Objective: To assess the safety and feasibility of a novel technique for distal embolic protection using balloon catheters during SA revascularization with a dual transfemoral and transradial access. Methods: We describe a case series of patients with SSS who underwent SAPTA due to severe stenosis or occlusion of the SA using a combined anterograde/retrograde approach. Transfemoral access to SA was obtained using large bore guide sheaths. Ipsilateral transradial access was obtained using intermediate bore catheters. A Scepter XC balloon catheter was introduced through the transradial intermediate catheter into the ipsilateral VA at the ostium during SAPTA for distal embolic protection. Results: A total of eight patients with SSS underwent subclavian SAPTA. Four patients had the combined anterograde/retrograde approach. Successful revascularization was achieved in three of them. It was difficult to create a channel in the fourth unsuccessful case due to heavily calcified plaque burden. No peri-operative ischemic events were identified. On follow-up, we demonstrated patency of the stents with resolution of symptoms and without any adverse events. Conclusion: Subclavian stenting using a combined transradial and transfemoral access with compliant balloon catheters at the vertebral ostium for prevention of distal emboli Fakih et al. Transradial-Transfemoral Approach for SSS may represent an alternative therapeutic approach for the treatment of SA stenosis and occlusions.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Combined Transradial and Transfemoral Approach With Ostial Vertebral Balloon Protection for the Treatment of Patients With Subclavian Steal Syndrome

et al. 2020

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“…Another technique that was developed to tackle the same issue is the "balloon-guiding catheter and the pull-through technique." Yamamoto et al reported the use of this technique to prevent embolism formation in the vertebral artery [49]. After a hybrid PTA and stenting procedure, the rate of recurrence is 41% higher in continuous as compared to intermittent SSS.…”

Section: Review Discussionmentioning

confidence: 99%

Subclavian Artery Calcification: A Narrative Review

Ahmed¹,

Parwani²,

Mahawar³

et al. 2022

Cureus

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Subclavian artery calcification (SAC) affects 2% of the population and presents a serious risk of developing into subclavian steal syndrome (SSS). Risk factors for plaque formation of the subclavian artery include diabetes, hypertension, and smoking. While SAC generally presents as asymptomatic, symptoms in severe cases may include numbness, pain at rest, and ischemic gangrene. Patients with severe SSS are at high risk of developing neurological symptoms as a result of vertebrobasilar insufficiency affecting posterior cerebral perfusion. On physical examination, SSS is preliminarily diagnosed from bilateral inter-arm systolic blood pressure discrepancy (>10 mmHg), which can be further confirmed with vascular imaging. Duplex ultrasound (DUS) is a cost-effective and non-invasive baseline technique for visualizing luminal stenosis and quantifying peak systolic velocity (PSV). Computed tomography angiography (CTA) provides high-quality, fast, three-dimensional (3D) imaging at the cost of introducing nephrotoxic contrast agents. Magnetic resonance angiography (MRA) is the safest 3D imaging modality, without the use of X-rays and contrast agents, that is useful in assessing plaque characteristics and degree of stenosis. DUS-assisted digital subtraction angiography (DSA) remains the gold standard for grading the degree of stenosis in the subclavian artery and determining the distance between the puncture site and lesion, which can be carried out in a combined procedure with endovascular management strategies. The fundamental treatment options are surgical and endovascular intervention. Endovascular treatment options include percutaneous transluminal angiography (PTA) for recanalization of the stenosed vessel and permanent balloon stenting to prevent collapse after PTA. Overall, the benefits of endovascular management encompass faster recovery, lower stenosis recurrence rate, and lower incidence of complications, making it the treatment of choice in low-risk patients. Surgical interventions, although more complex, are considered gold-standard treatment options.

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“…In the pull-through method, which allows for greater stabilization of the device, a guidewire is passed through from one sheath to another across the stenosis or obstructive lesion. 19) In the cerebrovascular region, this technique is applied to lesions in the subclavian and brachiocephalic arteries and at the origin of the VA. 20,21) Stabilization of the GC may also help ensure appropriate placement of the BE into the proximal portion of the SA. The pull-through method may also aid in positioning of the GCs while allowing for sufficient pushability and stability when the BE needs to be covered by the GC at the lesion location to avoid dropout of the stent, or when the deflated balloon is difficult to extract from the stent-mesh.…”

Section: Discussionmentioning

confidence: 99%

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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Feasibility and Safety of Distal and Proximal Combined Endovascular Approach with a Balloon-Guiding Catheter for Subclavian Artery Total Occlusion

Cited by 10 publications

References 12 publications

Combined Transradial and Transfemoral Approach With Ostial Vertebral Balloon Protection for the Treatment of Patients With Subclavian Steal Syndrome

Combined Transradial and Transfemoral Approach With Ostial Vertebral Balloon Protection for the Treatment of Patients With Subclavian Steal Syndrome

Subclavian Artery Calcification: A Narrative Review

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

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