[Excimer laser angioplasty for subclavian artery stenosis--case report]

Endovascular angioplasty for subclavian artery stenosis is effective and less invasive than other methods; however, it is difficult to advance guidewires or balloon catheters through severely stenotic lesions. We report a case of subclavian artery stenosis treated with excimer laser angioplasty. A 58-year-old man with hypertension and hyperlipidemia was admitted to a hospital with different blood pressure in each arm. A CT scan revealed left subclavian artery stenosis, and the patient was transferred to our hospital. An angiogram revealed a severely stenotic lesion in his left subclavian artery, representing subclavian steal phenomenon. Endovascular angioplasty was performed under local anesthesia with embolic protection for the left vertebral artery. The guidewire successfully crossed the lesion, and stepwise balloon angioplasty was performed using increasing balloon sizes from 1.5 to 2.0 mm; however, the next size balloon catheter could not cross the lesion, and we therefore decided to use an excimer laser catheter. After laser ablation, revascularization was performed via stent placement. The patient's symptoms and subclavian steal phenomenon improved, and the post-operative course was uneventful. Excimer laser angioplasty appears to be effective in the treatment of occlusive lesions that cannot be crossed using a balloon catheter.