Left Subclavian Artery Stenting: an option for the treatment of the Coronary-Subclavian Steal Syndrome

Abstract

Introduction The subclavian steal syndrome is characterized by the vertebral artery flow inversion, due to a stenotic lesion in the origin of the subclavian artery. The Coronary-subclavian Steal Syndrome is a variation of the Subclavian Steal Syndrome and is characterized by inversion of flow in the Internal Thracic artery that has been used as conduct in a myocardial revascularization. Its diagnosis must be suspected in patients with difference in pulse and arterial pressure in the upper limbs, that present with angina pectoris and that have done a myocardial revascularization. Its treatment must be a surgical bypass or a transluminal angioplasty. Objective The objective is to show the left subclavian artery stenting as a safe and effective method to treat the coronary-subclavian steal syndrome. Methods Historical prospective, non-randomized trial, through revision of the hospital records of the patients treated with the stenting of the left subclavian artery, from January 2006 to September 2012. Results In the mentioned period, 4.291 miocardial revascularizations were performed with the use of the left mammary artery, and 16 patients were identified to have the Coronary-subclavian steal syndrome. All of them were submitted to endovascular treatment. The success rate was 100%; two patients experienced minor complications; none of them presented with major complications. Eleven of the 16 patients had ultrassonographic documentation of patent stent for at least one year; two patients lost follow up and other two died. Conclusion The stenting of the left subclavian artery is a good option for the treatment of the Coronary-subclavian Steal Syndrome, with high level of technical and clinical success.

Subclavian artery stenting for coronary‐subclavian steal syndrome

“…Severe stenosis (≥70%) often caused stable or unstable angina or even myocardial infarction, whereas unstable angina or myocardial infarction were more frequent among occluded lesions because severe SAS compromised or even reversed the flow of IMA. Previous studies have shown that the symptomatic remission rate after the release of brachiocephalic and subclavian arterial stenosis fluctuates between 90% and 100% . The actuarial remission rate of 94.6% for subclavian artery stenting in this study reflected the effectiveness of this practice.…”

“…Overall, the incidence of CSSS was estimated to be 0.2–3.4% for patients with IMA‐CABG. Some case reports and small series have shown the feasibility of endovascular therapy of SAS for CSSS . However, due to small sample sizes and the short follow‐up durations of these studies, further exploration and evaluation were needed.…”

Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study

“…Endovascular treatment is the preferred procedure for treating vascular diseases such as dysfunctional arteriovenous fistula and steno-occlusive subclavian artery disease, and bleeding or tumor embolization [13][14][15][16][17][18]. The technical success or safety of the endovascular procedure has been sufficiently discussed in various fields [19][20][21]. Therefore, further interest has focused on the convenience of patients undergoing procedure rather than on its performance.…”

The Use of Radial Artery for CABG: An Update

“…However, proximal lesions are not infrequent. When left subclavian artery stenosis is present (up to 2% of patients undergoing coronary surgery) [ 34 ], the internal mammary artery flow can be jeopardized, and endovascular stenting may be indicated prior to arterial grafting [ 34 ]. In other cases, with proximal upper limb artery obstruction ( Figure 2(a) ), RA usage is not advised.…”

“…Angiographic radial artery stenosis was detected in 1.7% of cases in one study [ 35 ]. Among patients requiring coronary bypass grafting, the incidence of macroscopic RA calcification is approximately 6% [ 33 , 34 ]. The ulnar artery is then usually calcified as well.…”