Related Experiment Video
Updated: Aug 16, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Concomitant brachiocephalic and coronary artery disease: outcome and decision analysis
Thomas J Takach1, George J Reul, J Michael Duncan
1Department of Cardiovascular Surgery, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas, USA.
Insights
Treating brachiocephalic and coronary artery disease together improves outcomes. Both surgical and endovascular approaches for brachiocephalic reconstruction show excellent midterm patency, supporting further evaluation.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Concomitant brachiocephalic disease in patients with coronary artery disease complicates treatment decisions.
- Optimal management strategies for combined brachiocephalic and coronary artery disease require further investigation.
Purpose of the Study:
- To evaluate the outcomes of concomitant brachiocephalic reconstruction and coronary artery bypass grafting.
- To assess the efficacy of surgical versus endovascular brachiocephalic reconstruction for coronary-subclavian steal syndrome.
Main Methods:
- Eighty patients with combined brachiocephalic and coronary artery disease were analyzed.
- Group A (n=48) underwent simultaneous brachiocephalic reconstruction and coronary artery bypass grafting.
- Group B (n=32) had brachiocephalic reconstruction (surgical or endovascular) after prior coronary artery bypass grafting for coronary-subclavian steal syndrome.
Main Results:
- All patients were asymptomatic post-intervention with low operative mortality and perioperative stroke rates.
- Ten-year actuarial freedom from adverse events was favorable, particularly for patients receiving internal mammary artery conduits.
- Midterm follow-up demonstrated 100% brachiocephalic patency for both surgical and endovascular treatments in Group B.
Conclusions:
- Concomitant brachiocephalic reconstruction and coronary artery bypass grafting, especially with internal mammary artery conduits, warrants further study for improved long-term survival.
- Both surgical and endovascular brachiocephalic reconstruction techniques are effective for managing coronary-subclavian steal syndrome.
Background:
In patients with coronary artery disease, concomitant brachiocephalic disease may affect outcome and influence decision making regarding operative staging, technique, and choice of conduit.
Methods:
Eighty consecutive patients (mean age, 59.3 years; 60.0% male) with concomitant brachiocephalic and coronary artery disease were identified either before (group A, n = 48) or after (group B, n = 32) coronary artery bypass grafting. Patients who had symptomatic brachiocephalic and coronary artery disease before surgery underwent concomitant brachiocephalic reconstruction and coronary artery bypass grafting using either all-vein coronary conduits (n = 41) or vein-and-internal mammary artery conduits (n = 7). Patients who had coronary-subclavian steal syndrome after coronary artery bypass (group B, n = 32) underwent either surgical (n = 5) or endovascular (n = 27) brachiocephalic reconstruction only.
Results:
All patients were asymptomatic after intervention. Operative mortality was 4.2% for group A and 3.1% for group B. The perioperative stroke rate was 2.1% for group A and 0% for group B. Actuarial 10-year freedom from specific events for group A was as follows: death 59.9 +/- 12.8%, brachiocephalic restenosis 100%, coronary-subclavian steal syndrome 100%, myocardial infarction 83.5 +/- 10.5%, stroke 82.1 +/- 9.9%, redo coronary artery bypass grafting 95.8 +/- 4.1%, other vascular operation 82.2 +/- 8.9%, and adverse cardiac outcome (death, redo coronary artery bypass grafting, or myocardial infarction) 52.9% +/- 13.2% (for patients with all-vein conduits) or 100% (for patients with vein-and-internal mammary artery conduits). At midterm follow-up (mean, 2.92 years), both the surgical and the endovascular treatment subgroups of group B had 100% brachiocephalic patency.
Conclusions:
Long-term results in a limited population support continued evaluation of concomitant brachiocephalic reconstruction and coronary artery bypass grafting with use of the internal mammary artery conduit in an attempt to improve late survival in patients with concomitant disease. The excellent midterm brachiocephalic patency after either surgical or endovascular treatment of patients with coronary-subclavian steal syndrome supports continued evaluation of both methods.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:26Coronary Artery Disease IV: Preventive Measures
01:25Aortic Regurgitation III: Medical Management