Mid-term Outcomes Following Primary Covered Stent Implantation in Supra-Aortic Arch Vessels for Atherosclerotic...

The aim of this study was to present the mid-term outcomes of patients undergoing treatment for atherosclerotic stenosis or occlusion of the supra-aortic arch vessels using covered stents.

We conducted a retrospective, single-center analysis of patients treated for supra-aortic arch vessel atherosclerotic occlusive disease (AOD) at our institution between 2015 and 2024. The study included symptomatic patients who received endovascular treatment with covered stents for lesions involving the subclavian artery, proximal common carotid artery (pCCA), or the brachiocephalic trunk (BT). All patients underwent preprocedural computed tomography angiography within 6 months and color duplex ultrasonography before and after the intervention.

A total of 20 patients (8 male; mean age, 69.5±14.3 years) underwent primary covered stent implantation for supra-aortic arch vessel AOD, with 21 vessels treated (11 [52.4%], 6 [28.6%], and 4 [19.0%] in the subclavian artery, pCCA, and BT respectively). The main presenting symptoms were related to cerebrovascular insufficiency. Two patients presented with ischemic finger lesions due to subclavian artery occlusion. Technical success rate was 100% (21/21), and no intraoperative complications were recorded. Perioperative mortality was 0%. Two patients developed transient cerebral hyperperfusion syndrome after pCCA recanalization, one required temporary hemodialysis, and one underwent wound revision for access-site hematoma. Sixteen patients reported postoperative symptom resolution. Mean follow-up was 47.9±33.1 months (median, 40 months; interquartile range, 32 months). Mortality during follow-up was 30% (6/20), with no AOD-related deaths. During follow-up, no duplex ultrasound findings suggestive of >50% in-stent restenosis were detected, and no reinterventions were required.

Covered stent implantation for supra-aortic arch vessel atherosclerotic lesions appears to be associated with acceptable mid-term outcomes.