How to manage the left subclavian artery during endovascular stenting of the thoracic aorta

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Systematic Review and Meta-Analysis

Background:

• Stenting of the left subclavian artery (LSA) is a common endovascular procedure.
• Coverage of the LSA origin by aortic stent grafts can lead to complications.
• The necessity of revascularization in such cases remains debated.

Purpose of the Study:

• To systematically review the literature and evaluate the necessity of revascularization of the left subclavian artery territory when covered by a stent.
• To compare the outcomes of patients undergoing revascularization versus those not revascularized.

Main Methods:

• Systematic literature review including 99 studies.
• Analysis of data from 4906 patients.
• Comparison of incidences of left-arm ischemia, stroke, mortality, endoleak, and spinal-cord ischemia between revascularized and non-revascularized groups.

Main Results:

• Revascularization was associated with significantly lower incidences of left-arm ischemia (0.0% vs 9.2%) and stroke (4.7% vs 7.2%).
• However, revascularization also showed significantly increased mortality (10.5% vs 3.4%) and endoleak incidence (25.8% vs 12.6%).
• No significant difference in spinal-cord ischemia was observed between the groups.

Conclusions:

• Revascularization of the left subclavian artery territory after stenting may reduce downstream ischemic complications like arm ischemia and stroke.
• This intervention carries a significant risk of increased mortality and endoleaks.
• Indications for revascularization must be carefully considered on an individual patient basis, balancing potential benefits against risks.