Identifying high-risk patients for percutaneous transluminal angioplasty of subclavian and innominate arteries
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1Department of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi.
Insights
Percutaneous transluminal angioplasty showed success in non-occlusive subclavian and innominate artery stenoses. Patients with antegrade vertebral flow face a high risk of cerebral embolization during this procedure.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Subclavian and innominate artery obstructions can lead to significant upper extremity and cerebral ischemia.
- Percutaneous transluminal angioplasty (PTA) is a minimally invasive option for treating these atherosclerotic lesions.
Purpose of the Study:
- To evaluate the efficacy and safety of PTA for subclavian and innominate artery obstructions.
- To identify predictors of complications and restenosis after PTA.
Main Methods:
- Seven patients with 7 subclavian (4 stenoses, 3 occlusions) and 2 innominate artery stenoses underwent PTA via a percutaneous femoral approach.
- Ipsilateral percutaneous brachial puncture was used in 2 patients.
- Angiographic success, procedural complications, and clinical outcomes were assessed.
Main Results:
- Initial technical success was achieved in 4 of 6 stenoses (2 subclavian, 2 innominate) but in none of the 3 occlusions.
- Three patients experienced complications: 2 with cerebral embolization and 1 with angina pectoris.
- Patients with antegrade vertebral flow and no subclavian steal were at higher risk for cerebral embolization.
- No restenosis was detected during a mean follow-up of 10.8 months.
Conclusions:
- PTA is effective for selected non-occlusive subclavian and innominate artery stenoses, particularly those with subclavian steal.
- Antegrade vertebral flow without subclavian steal is a significant risk factor for cerebral embolization during PTA.
- Careful patient selection and procedural technique are crucial for optimizing outcomes.
Abstract:
We have performed percutaneous transluminal angioplasty for 7 subclavian (4 stenoses, 3 occlusions) and 2 innominate (both stenoses) artery obstructions in 7 patients by percutaneous femoral approach in all, and ipsilateral percutaneous brachial puncture in 2, patients. Initial success was obtained in 4 of the 6 stenoses (2 subclavian and both innominate) but in none of the 3 occlusions. Three of the 4 subclavian stenoses were located proximal to the vertebral artery origin and antegrade vertebral flow without subclavian steal was present in 2 of these lesions. Three patients had complications during the procedure. Two of them developed symptoms and signs of cerebral embolization. Both had shown antegrade vertebral flow and no evidence of subclavian steal in the initial angiogram. The third patient developed angina pectoris. The follow-up period ranged from 4 to 18 months (mean 10.8 months) and no re-stenosis was detected. Angioplasty appears suitable for management of a selected group of patients with nonocclusive lesions in whom subclavian steal phenomenon is evident in the initial diagnostic angiogram. The patients with antegrade vertebral flow are at a high risk of cerebral embolization during angioplasty.