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Percutaneous revascularization of atherosclerotic obstruction of aortic arch vessels
P Hadjipetrou1, S Cox, T Piemonte
1Interventional Cardiovascular Medicine, Lahey Clinic, Medical Center, Burlington, Massachusetts 01805, USA.
Insights
Stenting of aortic arch vessel obstruction offers effective treatment with 100% success and no major complications. This endovascular therapy demonstrates equal effectiveness to surgery but with a significantly better safety profile, suggesting it as a preferred first-line option.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Surgery has been the traditional treatment for subclavian and brachiocephalic obstruction.
- Limited comparative data exists between surgical therapy and endovascular stenting for these conditions.
Purpose of the Study:
- To compare the efficacy and safety of stenting versus surgical therapy for aortic arch vessel obstruction.
- To provide treatment recommendations based on comparative outcomes.
Main Methods:
- A prospective study of 18 patients undergoing stenting for symptomatic aortic arch vessel stenosis or occlusion.
- Clinical follow-up and noninvasive Doppler studies were performed.
- Data were compared with a systematic literature review of surgical and stenting series, analyzing technical success, complications, mortality, and patency.
Main Results:
- Stenting achieved 100% primary success, significantly improving stenosis and blood pressure with no major complications in the study series.
- Literature review indicated stenting has equivalent patency and complication rates compared to surgery.
- Published surgical series reported a 3-4% stroke incidence and 2-2% mortality.
Conclusions:
- Both stenting and surgery are effective for subclavian or brachiocephalic artery obstruction.
- Stenting demonstrates comparable effectiveness to surgery with fewer complications.
- Stenting should be considered the first-line therapy for these obstructions.
Objectives:
To compare stenting of aortic arch vessel obstruction with surgical therapy and to establish recommendations for treatment.
Background:
Though surgery has been considered to be the procedure of choice for subclavian and brachiocephalic obstruction, little work has been done to compare it with stenting.
Methods:
Eighteen patients with symptomatic aortic arch vessel stenosis or occlusion were treated with stenting, followed by periodic clinical follow-up and noninvasive arterial Doppler studies. Data were compared with the results as shown in a systematic review of a published series of surgery and stenting procedures which included comparison of technical success, complications, mortality and patency.
Results:
Primary success in our series was 100% with improvement in mean stenosis from 84+/-11% to 1+/-5% and mean arm systolic blood pressure difference from 44+/-16 mm Hg to 3+/-3 mm Hg. There were no major complications (death, stroke, TIA, stent thrombosis or myocardial infarction). At follow-up (mean 17 months), all patients were asymptomatic with 100% primary patency. Literature review demonstrates equivalent patency and complications in the other published series of stenting. In contrast, there was a similar patency but overall incidence of stroke of 3+/-4% and death of 2+/-2% in the published surgical series.
Conclusions:
Subclavian or brachiocephalic artery obstruction can be effectively treated by primary stenting or surgery. Comparison of stenting and the surgical experience demonstrates equal effectiveness but fewer complications and suggests that stenting should be considered as first line therapy for subclavian or brachiocephalic obstruction.