Initial experience with intentional stent-graft coverage of the subclavian artery during endovascular thoracic aortic...

To investigate the extent to which clinical status is affected by covering the left subclavian artery (LSA) with stent-grafts in the thoracic aorta.

Stent-graft reconstruction of the thoracic aorta was performed in 23 patients (20 men; mean age 50.8 years, range 17-77) for management of rupture (n = 11), type B dissection (n = 9), or aneurysm (n = 3). All patients had bilaterally equal systolic and diastolic blood pressures (141.3+/-19.8 and 78.9+/-11.0 mmHg, respectively). Twenty Gore TAG and 1 Talent thoracic endografts were used; 2 cases required a combination of prostheses. In all patients, the stent-graft was intentionally placed to cover the LSA. Follow-up included clinical examination with blood pressure measurements and computed tomography during the first postoperative week and at 3-month intervals thereafter.

After coverage of the LSA by the stent-graft, systolic pressure fell by a mean 48.3+/-23.4 mmHg. In 4 cases of proximal endoleak, however, systolic pressure fell by only 25.0+/-15.0 mmHg. Twenty (78.5%) patients reported no complaints during a mean follow-up of 12.1+/-7.3 months. Postinterventional complaints reported by 3 patients included exercise-dependent paresthesias; nonexercise-dependent, intermittent, and completely reversible dizziness; and a temperature difference between the upper extremities with no decrease in strength.

Covering the LSA is generally well tolerated by patients and increases the landing zone for the placement of thoracic stent-grafts. Long-term studies, however, must investigate the hemodynamic effects of this procedure on the vertebrobasilar circulation.