Related Experiment Videos
Percutaneous transluminal angioplasty of the subclavian arteries
Insights
Subclavian artery angioplasty with or without stenting is a safe and effective treatment for occlusive diseases, offering good long-term patency. Recanalizing occlusions proved more challenging, and stents did not significantly improve long-term outcomes.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- Subclavian artery occlusive disease presents with diverse symptoms, including vertebrobasilar insufficiency and upper limb ischemia.
- Percutaneous transluminal angioplasty (PTA) has emerged as a primary treatment modality for these conditions.
- The role of Palmaz stent placement in conjunction with PTA requires further evaluation for long-term efficacy.
Purpose of the Study:
- To assess the feasibility and safety of subclavian artery angioplasty.
- To evaluate the long-term results of angioplasty with and without Palmaz stent placement.
- To determine the risks associated with these endovascular interventions.
Main Methods:
- A 9-year retrospective review of 113 patients undergoing percutaneous balloon angioplasty for subclavian occlusive lesions.
- Indications included vertebrobasilar insufficiency, upper limb ischemia, coronary steal syndrome, and prophylactic stenting.
- Palmaz stents were selectively implanted for suboptimal dilation, becoming routine in 1995.
Main Results:
- Successful treatment was achieved in 91% of lesions; 53% of occlusions were not recanalized.
- Procedural complications occurred in 2.6% of patients, including one fatal stroke.
- Primary and secondary patency rates at 8 years were 75% and 81%, respectively, with no significant difference between stented and non-stented groups at shorter follow-up intervals.
Conclusions:
- Balloon angioplasty, with or without stenting, is a safe and effective treatment for subclavian artery occlusive disease.
- Good long-term patency rates were observed for successfully treated lesions.
- Recanalization of occlusions remains technically challenging, and routine stenting did not demonstrate improved long-term patency in this cohort.
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.