Percutaneous Transluminal Angioplasty of the Subclavian Arteries

Abstract

Purpose: To review the feasibility, risks, and long-term results of subclavian artery angioplasty with and without Palmaz stent placement. Methods: Over a 9-year period, 113 patients (67 males; mean age 63 ± 13 years) underwent percutaneous balloon angioplasty of subclavian occlusive lesions for a variety of indications: vertebrobasilar insufficiency (n = 70), upper limb ischemia (n = 50), coronary steal syndrome (n = 6), or anticipated coronary artery bypass grafting using the internal mammary artery in 12 asymptomatic patients. There were 94 (83%) stenoses and 19 (17%) occlusions with a mean percent stenosis of 80.1% ± 7.4% (range 70 to 100). Mean lesion length was 24 ± 8 mm (range 10 to 50). Beginning in 1989, stents were implanted for suboptimal dilation; in 1995, stenting became routine. Results: Overall, 103 (91%) of 113 lesions were successfully treated; 10 (53%) occlusions could not be recanalized. Fifty-one stents were implanted in 46 patients. There were 3 (2.6%) procedural complications: a transient ischemic attack, one major (fatal) stroke, and an arterial thrombosis 24 hours after the procedure (treated medically) (0.9% major stroke and death rate). During a mean 4.3-year follow-up (range to 10), 16 (15.5%) restenoses were treated with angioplasty (n = 4), stenting (n = 7), or surgery (n = 5). Primary and secondary patencies for all treated lesions (n = 113) at 8 years were 75% and 81%, respectively; in patients without initial stent placement, the rates were 69% and 76%, while in those with stents, the rates rose slightly to 87% and 94% at 2.5 years (NS). Patency rates for all 103 recanalized lesions were 83% and 90% at 8 years (81% and 90% without stent and 87% and 94% with stent at 2.5 years, respectively [NS]). Conclusions: Balloon angioplasty with or without stenting is safe and effective for treating subclavian artery occlusive diseases with good long-term patency. Recanalization of occlusions is more difficult to achieve. Stents (implanted only for suboptimal dilation) do not seem to improve long-term patency.

A case of acquired right-sided subclavian steal syndrome successfully treated with stenting using brachial approach

“…Although the initial success rate of PTA is high, the long-term angiographic patency is unclear and not ac- ceptable in many reports [26,41]. The use of stents appears to improve both acute and long-term results [42].…”

“…For either surgical or endovascular treatment, the indications are as follows: vertebrobasilar ischemia [22][23][24][25], upper limb ischemia, hand "claudication" and digital embolization [12,26,27], both of the preceding [24], angina in patients with a LIMA graft [28,29] and leg claudication in patients with axillo-femoral grafts [29]. Additional indications include increased flow for schedule operative procedure (i.e., LIMA graft, axillofemoral graft, dialysis graft) [30].…”

Long-Term Treatment Outcomes after Intravascular Ultrasound Evaluation and Stent Placement for Atherosclerotic Subclavian Artery Obstructive Lesions

“…The procedure was performed with the brachial artery approach alone in one case due to severe aortic tortuosity and bending. In the femoral artery approach, a pull-through technique 3 was used in two cases. In the femoral artery approach, a standard 9-Fr guiding catheter was used, and in the brachial artery approach, a 6-Fr guiding sheath was used.…”

Innominate Artery Stenting: A Single Centre Experience

“…A further evolution in the treatment of atherosclerotic lesions of the SATs occurred in the 1980s as percutaneous transluminal angioplasty (PTA) techniques were applied to these lesions. Initially these lesions were treated with PTA alone [6][7][8][9][10][11][12][13], but subsequent studies have reported an improvement in these initial results when stenting implantation was associated to balloon angioplasty [11,[14][15][16][17]. Recent reports, with short and midterm results, suggest that percutaneous treatment of the innominate arteries can be performed with relatively safety and expectations of satisfactory mid-term success [6,[9][10][11][12]18,19].…”