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Ammi M, Henni S, Salomon Du Mont L, Settembre N, Loubiere H, Sobocinski J, Gouëffic Y, Feugier P, Duprey A, Martinez R, Bartoli M, Coscas R, Chaufour X, Kaladji A, Rosset E, Abraham P, Picquet J. Lower Rate of Restenosis and Reinterventions With Covered vs Bare Metal Stents Following Innominate Artery Stenting. J Endovasc Ther 2019; 26:385-390. [DOI: 10.1177/1526602819838867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose: To determine any difference between bare metal stents (BMS) and balloon-expandable covered stents in the treatment of innominate artery atheromatous lesions. Materials and Methods: A multicenter retrospective study involving 13 university hospitals in France collected 93 patients (mean age 63.2±11.1 years; 57 men) treated over a 10-year period. All patients had systolic blood pressure asymmetry >15 mm Hg and were either asymptomatic (39, 42%) or had carotid (20, 22%), vertebrobasilar (24, 26%), and/or brachial (20, 22%) symptoms. Innominate artery stenosis ranged from 50% to 70% in 4 (4%) symptomatic cases and between 70% and 90% in 52 (56%) cases; 28 (30%) lesions were preocclusive and 8 (9%) were occluded. One (1%) severely symptomatic patient had a <50% stenosis. Demographic characteristics, operative indications, and procedure details were compared between the covered (36, 39%) and BMS (57, 61%) groups. Multivariate analysis was performed to determine relative risks of restenosis and reinterventions [reported with 95% confidence intervals (CI)]. Results: The endovascular procedures were performed mainly via retrograde carotid access (75, 81%). Perioperative strokes occurred in 4 (4.3%) patients. During the mean 34.5±31.2–month follow-up, 30 (32%) restenoses were detected and 13 (20%) reinterventions were performed. Relative risks were 6.9 (95% CI 2.2 to 22.2, p=0.001) for restenosis and 14.6 (95% CI 1.8 to 120.8, p=0.004) for reinterventions between BMS and covered stents. The severity of the treated lesions had no influence on the results. Conclusion: Patients treated with BMS for innominate artery stenosis have more frequent restenoses and reinterventions than patients treated with covered stents.
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Affiliation(s)
- Myriam Ammi
- Service de Chirurgie Vasculaire, CHU Angers, France
| | - Samir Henni
- Service de Médecine Vasculaire, CHU Angers, France
| | | | | | | | | | | | | | | | | | - Michel Bartoli
- Service de Chirurgie Vasculaire, Assistance Publique–Hôpitaux de Marseille, France
| | - Raphael Coscas
- Service de Chirurgie Vasculaire, Hôpital Ambroise Paré, Paris, France
| | | | | | - Eugenio Rosset
- Service de Chirurgie Vasculaire, CHU Clermont Ferrand, France
| | | | - Jean Picquet
- Service de Chirurgie Vasculaire, CHU Angers, France
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Hassan M, Mubarik A, Patel C, Haq F, Muddassir S. Atheroma of the Innominate Artery Presenting as a Transient Ischemic Attack. Cureus 2019; 11:e3961. [PMID: 30956913 PMCID: PMC6436674 DOI: 10.7759/cureus.3961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Supra-aortic atherosclerotic lesions, including innominate artery atheromas, are an uncommon but established cause of transient ischemic attacks, stroke, upper extremity ischemia, and vertebrobasilar insufficiency. We present a patient with a transient ischemic attack admitted with right hemispheric symptoms who was found to have a severe ulcerated innominate artery atheroma. The patient underwent an aortic arch angiogram with stenting of the innominate artery. The proper diagnosis, treatment, and management of innominate artery atheromas are imperative to prevent further cardiovascular morbidity and mortality in patients. Currently, both endovascular and surgical options are available for revascularization, and there have been no randomized controlled trials comparing endovascular versus open repair to standardize one as the standard of care over the other. No randomized controlled trials are examining the benefit of dual versus single antiplatelet therapy post-stenting in supra-aortic atherosclerotic lesions. We believe that this topic warrants further research and needs evidence-based guidelines to help direct physicians about treatment and management.
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Affiliation(s)
- Moin Hassan
- Internal Medicine, North Shore Medical Center, Salem, USA
| | - Ateeq Mubarik
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Chirag Patel
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Furqan Haq
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
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Endovascular Therapy for the Steal Phenomenon due to the Innominate Artery Severe Stenosis and Bilateral Internal Carotid Artery Severe Stenosis. World Neurosurg 2017; 105:1040.e1-1040.e5. [PMID: 28684367 DOI: 10.1016/j.wneu.2017.06.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Symptomatic innominate artery stenosis presenting as hemodynamic bilateral cerebral ischemia is uncommon. We present a rare case of the severe stenosis of the origin of an innominate artery and severe stenosis of bilateral internal carotid artery that induced hemodynamic cerebral ischemia after ipsilateral axillary artery-bilateral femoral artery bypass and was treated with stent replacement of the innominate artery and right internal carotid artery. CASE REPORT A 64-year-old woman who previously had undergone right axillary artery-bilateral femoral artery anastomosis for abdominal aorta high obstruction had been suffering from chronic dizziness and so visited our department. Findings of the examination included the severe stenosis of the origin of an innominate artery and severe stenosis of bilateral internal carotid artery, causing hemodynamic cerebral ischemia. She underwent stent replacement of the innominate artery and right carotid artery stenting via a right transbrachial approach. Her symptoms were relieved postoperatively. DISCUSSION For the sake of improving the hemodynamic cerebral ischemia, we performed stent replacement for innominate artery stenosis and right carotid artery stenting. Endovascular treatment of subclavian and innominate artery disease is a safe procedure. In addition, for the protection of thromboembolic migration, we performed balloon protection of the external carotid artery and filter protection of the internal carotid artery. CONCLUSIONS Stent replacement for these lesions can be performed safely with the right approach and protection methods, even when the only accessible route is the right brachial artery.
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Coronary-subclavian steal syndrome following CABG: A case report and literature review. Res Cardiovasc Med 2017. [DOI: 10.5812/cardiovascmed.34079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sharma S, Kaul U, Rajani M. Identifying High-Risk Patients for Percutaneous Transluminal Angioplasty of Subclavian and Innominate Arteries. Acta Radiol 2016. [DOI: 10.1177/028418519103200509] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Tang X, Long WA, Hu C, Tang F, Wang Q, Li L. The modified ‘no touch’ technique in the antegrade endovascular approach for left common carotid artery ostial stenosis stenting. J Neurointerv Surg 2016; 9:137-141. [DOI: 10.1136/neurintsurg-2016-012544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/20/2016] [Accepted: 07/29/2016] [Indexed: 11/04/2022]
Abstract
BackgroundOpen surgery and the retrograde endovascular approach via the distal left common carotid artery (LCCA) have some limitations in LCCA ostial stenosis treatment. The ‘no touch’ technique used in the renal artery was modified for this situation.MethodsFifteen selective LCCA stenosis patients were treated by the modified ‘no touch’ technique in the antegrade endovascular approach from March 2013 to March 2016. Thirteen underwent the transfemoral approach and the other two had the transbrachial approach due to a ‘bovine aortic arch’. Distal embolic protection devices were used in all cases. Follow-up included a neurological examination, carotid duplex scan, and office interview. Mean follow-up time was 18.2±11.5 months.ResultsThe initial technical success rate was 100%. The average procedure time was 84.0±16.3 min. There were no procedure-related deaths. No clinical neurological complications occurred during the in-hospital stay. No incidence of death or major stroke occurred during the follow-up period; 6.7% (1/15) of patients had a contralateral minor stroke, 66.7% (4/6) of symptomatic patients were relieved of initial symptoms, and the rest showed improvement. No patient developed new ipsilateral neurological symptoms and no in-stent restenosis occurred during the follow-up period. These results were confirmed by ultrasound.ConclusionsThe modified ‘no touch’ antegrade endovascular technique is a feasible method for treating LCCA ostial lesions with a satisfactory initial success rate, acceptable procedure time, and comparable mid- and long-term results. This technique could be considered as a complementary option for LCCA ostial stenosis in addition to open surgery and the retrograde endovascular approach.
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Costa SM, Fitzsimmons PJ, Terry E, Scott RC. Coronary-Subclavian Steal: Case Series and Review of Diagnostic and Therapeutic Strategies. Angiology 2016; 58:242-8. [PMID: 17495276 DOI: 10.1177/0003319707300371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Due to the increased use of internal mammary artery grafts for coronary revascularization, proximal subclavian stenosis resulting in coronary-subclavian steal has become an important clinical entity. Patients present with varying signs and symptoms of recurrent myocardial ischemia that not only can limit lifestyle but also be life-threatening. A careful history and physical examination with the identification of risk factors such as peripheral vascular disease and arm blood pressure differential >20 mm Hg can identify patents at high risk for developing this syndrome. Identifying these patients before coronary artery bypass grafting can prevent this important problem by altering the therapeutic approach to coronary revascularization. When patients present after coronary artery bypass grafting with coronary-subclavian steal, therapeutic options of percutaneous transluminal angioplasty and stent placement to the subclavian artery, carotid-subclavian bypass, and axillary-axillary bypass all have high success rates with excellent long-term patency rates. The choice for the type of revascularization needs to be individualized based on the lesion morphology and clinical comorbidities. Three patients who presented with signs and symptoms of myocardial ischemia due to coronary subclavian steal are presented. All 3 patients had incapacitating symptoms, and all 3 were treated successfully with different revascularization techniques due to other medical conditions or comorbidities.
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Affiliation(s)
- Steven M Costa
- Texas A&M University System Health Science Center, Scott and White Hospital, Division of Cardiology, Temple, TX 76508, USA.
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Diethrich EB, Cozacov JC. Subclavian Stent Implantation to Alleviate Coronary Steal through a Patent Internal Mammary Artery Graft. J Endovasc Ther 2016. [DOI: 10.1177/152660289500200111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Interventional techniques are rapidly supplanting conventional surgical therapies for the treatment of brachiocephalic occlusive disease. Although coronary-subclavian steal has been successfully alleviated with subclavian angioplasty, we report the first use of a Palmaz stent in the left subclavian artery (SCA) of a patient with a compromised left internal mammary artery (IMA) graft. Methods and Results: A 65-year-old male patient had undergone triple coronary artery bypass grafting in 1992, but 6 months later, severe narrowing occurred in two of the saphenous vein grafts, and arteriography identified a high-grade stenosis in the SCA supplying the left IMA graft to the left anterior descending coronary artery. Following balloon dilation of one saphenous vein graft stenosis, the left SCA was stented primarily with a P3008 Palmaz stent. Normal hemodynamics were restored, and the patient has been free of coronary steal symptoms for over 1 year. Conclusion: This case illustrates yet another aspect to the usefulness of intravascular stents in restoring and maintaining in flow to bypass grafts.
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Affiliation(s)
- Edward B. Diethrich
- Department of Cardiovascular Surgery, Arizona Heart Institute & Foundation, and the Cardiovascular Center of Excellence at Healthwest Regional Medical Center, Phoenix, Arizona
| | - Juan C. Cozacov
- Department of Cardiovascular Surgery, Arizona Heart Institute & Foundation, and the Cardiovascular Center of Excellence at Healthwest Regional Medical Center, Phoenix, Arizona
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Henry M, Amor M, Henry I, Ethevenot G, Tzvetanov K, Chati Z. Percutaneous Transluminal Angioplasty of the Subclavian Arteries. J Endovasc Ther 2016. [DOI: 10.1177/152660289900600106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To review the feasibility, risks, and long-term results of subclavian artery angioplasty with and without Palmaz stent placement. Methods: Over a 9-year period, 113 patients (67 males; mean age 63 ± 13 years) underwent percutaneous balloon angioplasty of subclavian occlusive lesions for a variety of indications: vertebrobasilar insufficiency (n = 70), upper limb ischemia (n = 50), coronary steal syndrome (n = 6), or anticipated coronary artery bypass grafting using the internal mammary artery in 12 asymptomatic patients. There were 94 (83%) stenoses and 19 (17%) occlusions with a mean percent stenosis of 80.1% ± 7.4% (range 70 to 100). Mean lesion length was 24 ± 8 mm (range 10 to 50). Beginning in 1989, stents were implanted for suboptimal dilation; in 1995, stenting became routine. Results: Overall, 103 (91%) of 113 lesions were successfully treated; 10 (53%) occlusions could not be recanalized. Fifty-one stents were implanted in 46 patients. There were 3 (2.6%) procedural complications: a transient ischemic attack, one major (fatal) stroke, and an arterial thrombosis 24 hours after the procedure (treated medically) (0.9% major stroke and death rate). During a mean 4.3-year follow-up (range to 10), 16 (15.5%) restenoses were treated with angioplasty (n = 4), stenting (n = 7), or surgery (n = 5). Primary and secondary patencies for all treated lesions (n = 113) at 8 years were 75% and 81%, respectively; in patients without initial stent placement, the rates were 69% and 76%, while in those with stents, the rates rose slightly to 87% and 94% at 2.5 years (NS). Patency rates for all 103 recanalized lesions were 83% and 90% at 8 years (81% and 90% without stent and 87% and 94% with stent at 2.5 years, respectively [NS]). Conclusions: Balloon angioplasty with or without stenting is safe and effective for treating subclavian artery occlusive diseases with good long-term patency. Recanalization of occlusions is more difficult to achieve. Stents (implanted only for suboptimal dilation) do not seem to improve long-term patency.
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Affiliation(s)
- Michel Henry
- Polyclinique Essey-les-Nancy, UCCI, Essey-les-Nancy, France
| | - Max Amor
- Polyclinique Essey-les-Nancy, UCCI, Essey-les-Nancy, France
| | - Isabelle Henry
- Polyclinique Essey-les-Nancy, UCCI, Essey-les-Nancy, France
| | | | | | - Zukaï Chati
- Polyclinique Essey-les-Nancy, UCCI, Essey-les-Nancy, France
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Duran M, Grotemeyer D, Danch MA, Grabitz K, Schelzig H, Sagban TA. Subclavian Carotid Transposition: Immediate and Long-Term Outcomes of 126 Surgical Reconstructions. Ann Vasc Surg 2015; 29:397-403. [DOI: 10.1016/j.avsg.2014.09.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/17/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
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Bradaric C, Kuhs K, Groha P, Dommasch M, Langwieser N, Haller B, Ott I, Fusaro M, Theiss W, von Beckerath N, Kastrati A, Laugwitz KL, Ibrahim T. Endovascular Therapy for Steno-Occlusive Subclavian and Innominate Artery Disease. Circ J 2015; 79:537-43. [DOI: 10.1253/circj.cj-14-0855] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christian Bradaric
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Kristin Kuhs
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Philip Groha
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Michael Dommasch
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Nicolas Langwieser
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Bernhard Haller
- Department of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München
| | - Ilka Ott
- German Heart Centre Munich, Technische Universität München
| | | | - Wolfram Theiss
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | | | - Adnan Kastrati
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance
- German Heart Centre Munich, Technische Universität München
| | - Karl-Ludwig Laugwitz
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
| | - Tareq Ibrahim
- Department of Cardiology, Klinikum Rechts der Isar, Technische Universität München
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Pellerin O, Delorme L, Bellmann L, Sapoval M. Clinical presentation and percutaneous endovascular management of acute left subclavian artery thrombosis: report of two cases. Diagn Interv Imaging 2013; 95:95-9. [PMID: 24012286 DOI: 10.1016/j.diii.2013.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- O Pellerin
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Interventional Radiology Department, Georges Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - L Delorme
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Interventional Radiology Department, Georges Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - L Bellmann
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Interventional Radiology Department, Georges Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - M Sapoval
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Interventional Radiology Department, Georges Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France
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13
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Nemes B. New possibilities in the endovascular treatment of supraaortic vessels. Interv Med Appl Sci 2011. [DOI: 10.1556/imas.3.2011.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Cerebrovascular disease, including stroke, represents the third-leading cause of death in Hungary and a leading cause of disability among the elderly population. The majority of all strokes are ischemic, mostly secondary to thromboembolic disease of the supraaortic vessels. We investigated new therapeutic methods in the endovascular treatment of these diseases. Surgical revascularization of supraaortic trunk stenosis is associated with high morbidity and mortality rates. Balloon angioplasty has become an increasingly accepted treatment of stenoocclusive supraaortic arterial disease. Natural history data and treatment guidelines do not exist for innominate and proximal common carotid artery lesions. We have confirmed in a large series of innominate artery angioplasties that it is a safe and effective procedure with an excellent initial success rate, with a lower complication rate than the surgical option and with a similar long-term patency rate as for surgery.
In the largest published study on transfemoral angioplasty of ostial and proximal common carotid artery stenosis we have proved that endovascular treatment has high success rate with low stroke/death rate. Carotid stenting (CAS) is an evolving alternative to surgery in the treatment of patients with carotid stenosis. Stent selection is influenced by several factors, including the carotid anatomy and lesion characteristics. We examined the wall adaptability of a new closed-cell carotid stent (NexStent), which was designed for carotid bifurcation treatment. Data obtained from angiographic and computed tomographic images indicate that the stent provides adequate expansion and adaptation to the carotid bifurcation.
There are two types of restenosis after carotid artery interventions: the early restenosis develops mainly within the first 24 months after the revascularization procedure and its pathological background is myointimal hyperplasia; on the other hand late restenosis is rather due to progression of primary atherosclerosis and occurs more than 2 years after carotid endarterectomy (CEA). We compared the early restenosis rate in a consecutive series of CAS versus CEA patients at a single cardiovascular institution. The data suggest that the incidence of restenosis after stenting was less common than after surgery.
Our results may help vascular surgeons and interventional radiologists to consider risk versus benefit when deciding treatment options for supraaortic arterial stenosis.
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Affiliation(s)
- Balázs Nemes
- 1 Heart Center, Semmelweis University, Városmajor u. 68, H-1122, Budapest, Hungary
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Paukovits TM, Nemes B, Hüttl K, Bérczi V. [Percutaneous, endovascular treatment of innominate artery lesions is a safe and effective procedure]. Orv Hetil 2011; 152:1745-50. [PMID: 21983401 DOI: 10.1556/oh.2011.29221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Percutaneous endovascular treatment (transluminar balloon angioplasty with or without stent implantation) of innominate artery lesions has become the treatment of choice prior to surgery in the past decades. Authors present the diagnostics, treatment and follow-up of two patients as examples from their largest series in the literature. A 74-year-old male patient with a history of hyperlipidemia, hypertension, nicotine abuse and lower limb claudication was admitted because of acute upper limb claudication and dizziness. Physical examination revealed blood pressure difference of 30 mmHg between his arms, and poststenotic flow pattern in the common carotid artery with retrograde flow in the vertebral artery on carotid duplex scan. Diagnostic angiography showed 80% stenosis of the innominate artery, which was treated with percutaneous transluminar balloon angioplasty with stent implantation. Follow-up examination at 5 months showed no significant restenosis or neurological complication. The second patient was a 59-year-old smoker female patient with hypertension and type 2 diabetes mellitus, who was evaluated for her upper limb claudication. Initial finding was the absence of radial pulse in the right side. Color duplex scan revealed proximal subocclusion, which was confirmed by angiography. In one stage, balloon angioplasty was made, with immediate pain relief. After 15 months the patient was symptom-free. These two cases demonstrate an excellent outcome of endovascular treatment of innominate artery lesions, as authors already reported in two retrospective studies. Balloon angioplasty with, or without stent deployment appears to be a safe procedure with excellent primary success rate. Review of international studies also indicates that endovascular therapy of the innominate artery is safe and effective.
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Affiliation(s)
- Tamás Mirkó Paukovits
- Semmelweis Egyetem, Általános Orvostudományi Kar Cardiovascularis Centrum Budapest Gál József u. 9. 1122.
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Abstract
Endovascular treatment of supra-aortic atherosclerotic arterial stenoses and occlusions using percutaneous transluminal angioplasty (PTA) and stent placement is an accepted first-choice procedure. Technical success, primary success, and midterm patency after PTA and stent placement for the treatment of stenosed or obstructed brachiocephalic arteries are promising and complication rates are low. Permanent miniaturization and device improvement makes treatment of atherosclerotic obstructive disease by endovascular means in brachial and cephalic arteries a safe procedure showing promising midterm patency rates.
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Affiliation(s)
- S Müller-Hülsbeck
- Department of Radiology, University Hospitals Schleswig-Holstein-Campus Kiel, Kiel, Germany
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Endovascular and Open Surgical Treatment of Brachiocephalic Arteries. Ann Vasc Surg 2011; 25:569-81. [DOI: 10.1016/j.avsg.2010.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 10/15/2010] [Accepted: 10/17/2010] [Indexed: 11/19/2022]
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17
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Ryer EJ, Oderich GS. Two-Wire (0.014 & 0.018-Inch) Technique to Facilitate Innominate Artery Stenting Under Embolic Protection. J Endovasc Ther 2010; 17:652-6. [DOI: 10.1583/10-3156.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Late Stent Fractures after Endoluminal Treatment of Ostial Supraaortic Trunk Arterial Occlusive Lesions. J Vasc Interv Radiol 2010; 21:1364-9. [DOI: 10.1016/j.jvir.2010.04.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 03/30/2010] [Accepted: 04/29/2010] [Indexed: 11/23/2022] Open
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Percutaneous Endovascular Treatment of Innominate Artery Lesions: A Single-centre Experience on 77 Lesions. Eur J Vasc Endovasc Surg 2010; 40:35-43. [DOI: 10.1016/j.ejvs.2010.03.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 03/12/2010] [Indexed: 11/22/2022]
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20
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Stiefel MF, Park MS, McDougall CG, Albuquerque FC. Endovascular Treatment of Innominate Artery Occlusion With Simultaneous Vertebral and Carotid Artery Distal Protection. Neurosurgery 2010; 66:E843-4; discussion E844. [DOI: 10.1227/01.neu.0000367549.33541.34] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Atherosclerotic stenosis or obstruction of the innominate artery is rare. Traditional surgical management is a technically demanding intervention with acceptable, but not negligible, rates of morbidity and mortality. Endovascular approaches to supraaortic lesions have been successful and are now the preferred treatment for stenoses of the brachiocephalic vessels. The use of cerebral protection devices in subclavian and innominate interventions is less established.
CLINICAL PRESENTATION
A 58-year-old woman had Takayasu giant cell arteritis with a history of a left middle cerebral artery stroke 3 weeks after undergoing placement of a left common carotid artery (CCA) stent and right innominate artery stent in 1998. She recently presented with worsening dizziness, ataxia, and right arm numbness and was referred to the endovascular neurosurgery service for management.
INTERVENTION
Initial angiography revealed left CCA stenosis and right innominate occlusion. The patient initially underwent left CCA angioplasty, planned as a staged procedure. This was followed by recanalization of the right innominate artery through an approach using both femoral arteries and the right brachial artery. This 3-site technique allowed simultaneous distal protection of both the right cervical vertebral and carotid arteries.
CONCLUSION
Reopening a chronically occluded innominate artery risks an embolic shower through both the right vertebral and carotid arteries. Using multiple sites of arterial access, distal protection devices can be deployed in both the cervical vertebral and carotid arteries to reduce the risk of stroke.
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Affiliation(s)
- Michael F. Stiefel
- Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Min S. Park
- Division of Neurological Surgery, University of California, San Diego Medical Center, San Diego, California
| | - Cameron G. McDougall
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Felipe C. Albuquerque
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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21
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Transfemoral endovascular treatment of proximal common carotid artery lesions: A single-center experience on 153 lesions. J Vasc Surg 2008; 48:80-7. [DOI: 10.1016/j.jvs.2008.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 03/03/2008] [Accepted: 03/03/2008] [Indexed: 11/17/2022]
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22
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Bakken AM, Palchik E, Saad WE, Hart JP, Singh MJ, Rhodes JM, Waldman DL, Davies MG. Outcomes of Endoluminal Therapy for Ostial Disease of the Major Branches of the Aortic Arch. Ann Vasc Surg 2008; 22:388-94. [DOI: 10.1016/j.avsg.2007.07.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 07/08/2007] [Accepted: 07/18/2007] [Indexed: 11/30/2022]
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Patel SN, White CJ, Collins TJ, Daniel GA, Jenkins JS, Reilly J, Morris RF, Ramee SR. Catheter-based treatment of the subclavian and innominate arteries. Catheter Cardiovasc Interv 2008; 71:963-8. [DOI: 10.1002/ccd.21549] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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24
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van Hattum ES, de Vries JPPM, Lalezari F, van den Berg JC, Moll FL. Angioplasty with or without Stent Placement in the Brachiocephalic Artery: Feasible and Durable? A Retrospective Cohort Study. J Vasc Interv Radiol 2007; 18:1088-93. [PMID: 17804769 DOI: 10.1016/j.jvir.2007.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the results of percutaneous transluminal angioplasty (PTA) and stent placement in isolated brachiocephalic trunk lesions. MATERIALS AND METHODS PTA, with or without stent placement, was used to treat 30 patients with isolated clinically significant stenoses (n = 25) or occlusions (n = 5) of the brachiocephalic artery. Initial clinical success was defined as a relief or substantial reduction of the preprocedural symptoms, and initial technical success was defined as a mean translesion pressure gradient of less than 5 mm Hg or a residual stenosis of less than 20%. Clinical evaluation and duplex Doppler ultrasonography of the lesion site were performed at follow-up. Clinical restenosis was defined as recurrent clinical symptoms and a lumen reduction of more than 50%, determining the primary clinical patency. Technical restenosis was defined as more than 50% lumen reduction with or without renewed clinical symptoms, determining the primary technical patency. RESULTS The initial technical success rate was 83% (occlusions, 60%; stenoses, 88%), and the clinical success rate was 81%. Two patients had major complications, and four experienced minor complications. At a median follow-up of 24 months (4 weeks to 92 months), the primary clinical patency rate was 79% (95% confidence interval [CI]: 57%, 104%), with 83% (95% CI: 60%, 105%) for arteries with stents and 67% (95% CI: 13%, 120%) for those without stents (P = .11). The primary technical patency rate was 50% (95% CI: 24%, 76%). CONCLUSION PTA with or without stent placement in a stenotic or occlusive brachiocephalic artery is a procedure of tolerable safety with a high initial success rate; however, only moderately rewarding results were obtained after 2 years. Selective stent placement probably improves long-term success. Primary PTA with selective stent placement in an atherosclerotic obstructive brachiocephalic artery should be considered the preferred treatment option.
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Affiliation(s)
- Eline S van Hattum
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands.
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25
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Müller-Hülsbeck S, Both M, Charalambous N, Schäfer PJ, Heller M, Jahnke T. Endovaskuläre Behandlung arteriosklerotisch bedingter arterieller Stenosen und Okklusionen der Aortenbogengefäße: Mittelfristige Ergebnisse einer Ein-Center-Analyse. ACTA ACUST UNITED AC 2007; 56:119-28. [PMID: 17390951 DOI: 10.1016/j.rontge.2006.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine mid-term patency rates after endovascular treatment of supraaortic atherosclerotic arterial stenoses and occlusions using percutaneous transluminal angioplasty (PTA) and stent placement. PATIENTS AND METHODS During a period of 83 months, 48 patients (18 female, 30 male; mean age 61 years, range 31-82 years) were included into this prospective single-center study. Fifty-five lesions of the brachial and cephalic arteries (subclavian/axillary artery n = 42, innominate artery n = 7, origin common carotid artery n = 6) were treated using PTA (n = 38), PTA plus stent (n = 11) or primary stent placement (n = 6). For anticoagulation, patients received a bolus of heparin (5000 IU) intraarterially during the intervention followed by intravenous application for 24h. At discharge, life-time application of ASA (100mg/day) was initiated. Follow-up protocol included clinical examination, colour-coded duplex ultrasound and intraarterial angiography in case of re-stenosis. RESULTS PTA and stent placement were technically successful in all patients (100%). No major complications occurred. Of seven patients presenting with total occlusions, six were treated with stent placement. Stent implantation was also performed in all lesions located at the origin of the supraaortic arteries (n = 6). In 38 lesions, the result of PTA was satisfactory. Mean follow-up time is 22 months (range 1-83 months). During follow-up examinations, re-stenoses occurred in 10 cases (at 1 month n = 2, at 6 months n = 2, at 12 months n = 3, at 24 months n = 3). In 9 lesions, re-interventions were performed (PTA n = 7; PTA plus stent n = 2). According to Kaplan-Meier life-table analysis, cumulative primary and primary assisted patency rates are 69.5% (patients at risk n = 15; standard error 9%) and 90.6% (patients at risk n = 16; standard error 6.3%) at 20 months, respectively. CONCLUSIONS Endovascular treatment of atherosclerotic obstructive disease in brachial and cephalic arteries is a safe procedure showing promising mid-term patency rates.
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Affiliation(s)
- Stefan Müller-Hülsbeck
- Universitätsklinikum Schleswig-Holstein--Campus Kiel, Klinik für Diagnostische Radiologie, Arnold-Heller-Strasse 9, 24105 Kiel, Germany.
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26
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Brountzos EN, Malagari K, Kelekis DA. Endovascular Treatment of Occlusive Lesions of the Subclavian and Innominate Arteries. Cardiovasc Intervent Radiol 2006; 29:503-10. [PMID: 16729226 DOI: 10.1007/s00270-005-0124-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Elias N Brountzos
- Second Department of Radiology, Eugenidion Hospital, Athens University Medical School, Athens, Greece.
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Przewlocki T, Kablak-Ziembicka A, Pieniazek P, Musialek P, Kadzielski A, Zalewski J, Kozanecki A, Tracz W. Determinants of immediate and long-term results of subclavian and innominate artery angioplasty. Catheter Cardiovasc Interv 2006; 67:519-26. [PMID: 16547924 DOI: 10.1002/ccd.20695] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Percutaneous angioplasty (PTA) is widely used in the treatment of subclavian/innominate artery obstruction, but factors of long-term PTA outcome are poorly understood. Our aim was to evaluate the efficiency of PTA on symptom resolution and identify determinants of long-term outcome. METHODS AND RESULTS Seventy-six lesions were treated in 75 patients (58.7% men) aged 60 +/- 8.5 years. PTA was successful in 70 (93.3%) patients, including 58/58 (100%) stenotic lesions and 13/18 (72.2%) occlusions. The mean stenosis grade (QCA) was reduced from 78.9% +/- 16.6% to 13.5% +/- 10.7% (P < 0.01). A great majority of lesions (87.1%) were stented. In 5 (7.1%) high-risk lesions a proximal or distal neuroprotection system was used. There were no strokes or embolic events. Minor complications occurred in 7 (9.3%) cases. Fifty-seven (89%) of 64 symptomatic patients had complete symptom resolution. The mean follow-up was 24.4 +/- 15.5 months (up to 66 months). Ten restenoses (15.6%), including 9 (13.8%) in-stent restenoses and 1 (16.7%) restenosis after balloon angioplasty, were diagnosed in 64 patients and followed up for at least 6 months. Nine symptomatic restenoses were successfully treated with repeated angioplasty. Cox multivariable analysis revealed the following independent predictors of restenosis: implantation of more than one stent (P = 0.005), low stent diameter (P = 0.088), and postprocedural systolic blood pressure difference between upper extremities (P = 0.044). CONCLUSIONS PTA is a safe and effective method for the treatment of the subclavian/innominate artery obstruction and leads to symptom resolution in majority of patients. Restenosis is not frequent and it can be effectively treated with repeat angioplasty. Low stent diameter, implantation of two stents, and upper limb systolic blood pressure difference are independent predictors of restenosis.
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Affiliation(s)
- Tadeusz Przewlocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
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28
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Modarai B, Ali T, Dourado R, Reidy JF, Taylor PR, Burnand KG. Comparison of extra-anatomic bypass grafting with angioplasty for atherosclerotic disease of the supra-aortic trunks. Br J Surg 2004; 91:1453-7. [PMID: 15386319 DOI: 10.1002/bjs.4751] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Symptomatic stenosis of the supra-aortic trunks (subclavian, innominate and common carotid arteries) can be treated by angioplasty/stenting or surgical bypass. The aim of this study was to compare the initial success and outcome of these two types of treatment.
Methods
A prospective database was used to collect information on the presentation, initial success, complications and outcome in 76 patients treated in a single centre between 1983 and 2003.
Results
Thirty-five surgical extra-anatomic bypasses were performed, 13 carotid to carotid, 14 carotid to subclavian, two carotid to axillary, three axillary to axillary, one subclavian to axillary and two subclavian to subclavian. One graft occluded after 19 years. No limbs were amputated and no patient had a stroke. The secondary patency rate was 97 per cent at a mean follow-up of 5 years. Forty-one angioplasties were attempted, 34 of the left subclavian, six of the right subclavian and one of the innominate artery. Angioplasty for six subclavian occlusions was unsuccessful. Twenty-seven of 33 arteries remained patent at a mean follow-up of 4 years after a successful endovascular procedure.
Conclusion
Extra-anatomic bypass for supra-aortic trunk disease has a better patency than angioplasty, with a comparable complication rate.
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Affiliation(s)
- B Modarai
- Department of Surgery, Guy's and St Thomas' Hospitals, London, UK
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29
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Khaw AV, Schumacher HC, Meyers PM, Gupta R, Higashida RT. Extracranial revascularization therapy: Angioplasty and stenting. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2004; 6:179-192. [PMID: 15096309 DOI: 10.1007/s11936-996-0012-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Beginning with simple balloon angioplasty, minimally invasive revascularization techniques have progressed to the use of metallic stents for improved immediate and long-term results. Stent-supported angioplasty now offers a therapeutic option for those individuals ineligible for surgical revascularization of stenotic atherosclerotic lesions and who have failed maximal medical therapy. However, the clinical equivalence, or possibly even superiority, of angioplasty of the extracranial carotid and vertebral arteries in atheromatous occlusive disease over surgical revascularization has yet to be determined in ongoing randomized controlled trials. Additionally, endovascular techniques offer treatment for a variety of nonatherosclerotic disease affecting the extracranial arteries, such as inflammatory, radiation-induced, and postsurgical strictures; acute intimal dissection; traumatic and spontaneous arteriovenous fistulas; and aneurysms or pseudoaneurysms. For certain disease entities at high risk for surgical complications, endovascular procedures have gained preference as the therapeutic modality of choice, yet lacking controlled trials providing evidence for noninferiority against surgical approach. Continued innovation and refinement of endovascular technology and techniques will further improve technical success, reduce procedure-related morbidity, and broaden the endovascular therapeutic spectrum for extracranial and intracranial cerebrovascular disease.
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Affiliation(s)
- Alexander V. Khaw
- Neuroendovascular Service, Departments of Radiology and Neurological Surgery, Columbia and Cornell University Medical Centers, Neurological Institute
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30
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Yaneza LO, Sun LL, Bagsit NLA, Baysa AN, Torres RN, Dy TC. Angioplasty of an asymptomatic total occlusion of the left subclavian artery to provide access for coronary angiography and intervention: A case report. Catheter Cardiovasc Interv 2004; 61:310-3. [PMID: 14988885 DOI: 10.1002/ccd.10772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Reports and follow-up of angioplasty and stenting of asymptomatic totally occluded subclavian arteries are limited. We present a case of unstable angina and arterial occlusion of all four extremities treated with subclavian angioplasty and stenting with subsequent coronary angiography and percutaneous coronary intervention. Twelve-month follow-up is also provided.
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Affiliation(s)
- Liberty O Yaneza
- Section of Interventional Cardiology, Division of Invasive, Diagnostic and Therapeutic Cardiology, Philippine Heart Center, Quezon City, Philippines
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31
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Walter J, Hofmann WJ, Ugurluoglu A, Magometschnigg H. False aneurysm after balloon dilation of a calcified innominate artery stenosis. J Endovasc Ther 2003; 10:825-8. [PMID: 14533958 DOI: 10.1177/152660280301000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the occurrence of a false aneurysm after percutaneous transluminal angioplasty of a severely calcified, high-grade stenosis of the brachiocephalic trunk. CASE REPORT A 68-year-old patient was admitted with cerebrovascular insufficiency, right upper extremity ischemia, and recurrent amaurosis fugax. Magnetic resonance arteriography (MRA) and duplex ultrasound revealed a severely calcified, high-grade stenosis of the innominate artery. Balloon dilation of this lesion was performed with minimal morphological success. After dilation, the patient suffered a reversible ischemic neurological deficit, from which he recovered completely. The patient's symptoms improved, but after 3 weeks he was re-admitted with palsy of the recurrent laryngeal nerve. An MRA showed a false aneurysm at the dilation site. Open surgery was performed, and the patient received a bifurcated aorto-subclavian-carotid bypass graft. He was discharged free of his preoperative symptoms. CONCLUSIONS This case illustrates the potential hazards of angioplasty of severely calcified stenoses of the supra-aortic vessels.
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Affiliation(s)
- Johannes Walter
- Department of Vascular Surgery, St John's Hospital, Salzburg, Austria.
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32
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Walter J, Hofmann WJ, Ugurluoglu A, Magometschnigg H. False Aneurysm After Balloon Dilation of a Calcified Innominate Artery Stenosis. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0825:faabdo>2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sagić D, Radak D, Perić M, Ilijevski N, Sajić Z, Petrović BB, Mirić M. [Endovascular procedures in the treatment of obstructive lesions of the brachiocephalic arteries]. VOJNOSANIT PREGL 2002; 59:255-9. [PMID: 12132238 DOI: 10.2298/vsp0203255s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To assess the early effects, possible risks, and long term results of percutaneous transluminal angioplasty (PTA) of brachiocephalic trunk (BT) and subclavian arteries (SA). METHODS During the period of 11 years, in 92 patients (57 males--62%, mean age 53.5 +/- 7.8 years) 93 PTA of SA/BT were performed; 70 (75%) lesions were stenosis, while 23 (25%) lesions were occlusions with mean diameter stenosis percent of 83.1 +/- 6.2%. Clinical indications were: vertebrobasilar insufficiency (n = 57), upper limb ischemia (n = 40), coronary steal syndrome (n = 4) and scheduled aorto-coronary bypass, using internal thoracic artery (ITA) (n = 4 asymptomatic patients). Mean lesion length was 22 +/- 8 mm. RESULTS Eighty one (87%) out of 93 lesions were successfully dilated; all of 12 (13%) failures were due to unsuccessful recanalisation of occluded arteries. In 10 patients 10 stents were implanted (2 in BT and 8 in left SA). There were 6 (6.5%) procedural complications: 1 dissection, 1 thrombosis of the left SA, transient ischemic attack in 2 patients, and 2 cases of dislocation of atheromatous plaque from the right SA into the right common carotid artery. During the follow-up of 48 +/- 3 months, 16(20%) restenoses were treated by PTA (n = 7) or operatively (n = 9). Primary and secondary patency for all lesions treated during 11 years was 87% and 80%, respectively (stenosis: 97% and 89%; occlusions: 58% and 58%). CONCLUSION PTA with or without stenting was relatively simple, efficient and safe procedure. It required short hospitalization with low treatment costs. If any of suboptimal results or chronic occlusions were present, the implantation of endovascular stents should have been considered.
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Affiliation(s)
- Dragan Sagić
- Institut za kardiovaskularne bolesti Dedinje, Beograd
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Abstract
Dotter first described percutaneous revascularization of peripheral vascular disease (PVD) in 1964. In 1974, Gruentzig developed a balloon catheter for dilation of vascular lesions. Currently, percutaneous transluminal angioplasty (PTA) employs a variety of devices ranging from implantable stents to endovascular radiation devices for re-stenosis and is recognized as a safe and effective alternative to surgery for selected patients. In addition to the general efficacy of peripheral angioplasty, which is comparable to that of bypass surgery for selected lesions, angioplasty offers several distinct advantages over surgery. It is performed under local anaesthesia, making it feasible to treat patients who are at high risk for general anaesthesia. When compared to surgical revascularization, the morbidity from angioplasty is low, generally related to problems at the vascular access site, and mortality is extremely rare. Unlike vascular surgery, there is no recovery period after angioplasty, and most patients can return to normal activity within 24-48 h of an uncomplicated procedure. Finally, angioplasty can be repeated if necessary usually without increased difficulty or increased patient risk compared to the first procedure, and does not preclude surgery as adjunctive or definitive therapy.
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Affiliation(s)
- C J White
- Department of Cardiology, Ochsner Heart and Vascular Institute, New Orleans, Louisiana 70121, USA
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Sheiban I, Dharmadhikari A, Melissano G, Tzifos V, Montorfano M, Leonardo F, Di Mario C, Chiesa R, Colombo A. Subclavian artery stenting: Immediate and mid term clinical follow-up results. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2000; 3:231-235. [PMID: 12431348 DOI: 10.1080/14628840050515984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND: Intravascular stents are increasingly being used to treat subclavian artery obstructive disease. This study aimed to assess the immediate and mid-term clinical outcome of subclavian artery stenting. METHODS AND RESULTS: Total occlusion of the subclavian artery was seen in 7 (28%) out of the 25 consecutive patients treated for subclavican artery stenosis. Mean lesion length was 14 +/- 4.3 mm. The mean preprocedure diameter stenosis was reduced from 83.2 +/- 14.9% to 9.6 +/- 5.4% postprocedure. Procedural success was achieved in all patients. Clinical follow-up was obtained in all patients. The initial success was maintained at follow-up (mean = 12 +/- 4 months) in 24 (96%) patients. Recurrence of symptoms occurred in 1 (4%) patient who had an angiographically documented restenosis four months after the procedure. It was successfully redilated. CONCLUSION: Stenting for subclavian artery obstructive disease is safe, technically feasible and has favorable clinical outcomes. It may be considered as the therapy of choice for subclavian artery obstructive disease.
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Affiliation(s)
- Imad Sheiban
- Division of Cardiology, Interventional Cardiology Laboratory, University of Torino, Torino, Italy
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36
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Phatouros CC, Higashida RT, Malek AM, Meyers PM, Lefler JE, Dowd CF, Halbach VV. Endovascular Treatment of Noncarotid Extracranial Cerebrovascular Disease. Neurosurg Clin N Am 2000. [DOI: 10.1016/s1042-3680(18)30136-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Henry M, Amor M, Henry I, Ethevenot G, Tzvetanov K, Chati Z. Percutaneous transluminal angioplasty of the subclavian arteries. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1999; 6:33-41. [PMID: 10088888 DOI: 10.1583/1074-6218(1999)006<0033:ptaots>2.0.co;2] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To review the feasibility, risks, and long-term results of subclavian artery angioplasty with and without Palmaz stent placement. METHODS Over a 9-year period, 113 patients (67 males; mean age 63 +/- 13 years) underwent percutaneous balloon angioplasty of subclavian occlusive lesions for a variety of indications: vertebrobasilar insufficiency (n = 70), upper limb ischemia (n = 50), coronary steal syndrome (n = 6), or anticipated coronary artery bypass grafting using the internal mammary artery in 12 asymptomatic patients. There were 94 (83%) stenoses and 19 (17%) occlusions with a mean percent stenosis of 80.1% +/- 7.4% (range 70 to 100). Mean lesion length was 24 +/- 8 mm (range 10 to 50). Beginning in 1989, stents were implanted for suboptimal dilation; in 1995, stenting became routine. RESULTS Overall, 103 (91%) of 113 lesions were successfully treated; 10 (53%) occlusions could not be recanalized. Fifty-one stents were implanted in 46 patients. There were 3 (2.6%) procedural complications: a transient ischemic attack, one major (fatal) stroke, and an arterial thrombosis 24 hours after the procedure (treated medically) (0.9% major stroke and death rate). During a mean 4.3-year follow-up (range to 10), 16 (15.5%) restenoses were treated with angioplasty (n = 4), stenting (n = 7), or surgery (n = 5). Primary and secondary patencies for all treated lesions (n = 113) at 8 years were 75% and 81%, respectively; in patients without initial stent placement, the rates were 69% and 76%, while in those with stents, the rates rose slightly to 87% and 94% at 2.5 years (NS). Patency rates for all 103 recanalized lesions were 83% and 90% at 8 years (81% and 90% without stent and 87% and 94% with stent at 2.5 years, respectively [NS]). CONCLUSIONS Balloon angioplasty with or without stenting is safe and effective for treating subclavian artery occlusive diseases with good long-term patency. Recanalization of occlusions is more difficult to achieve. Stents (implanted only for suboptimal dilation) do not seem to improve long-term patency.
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Affiliation(s)
- M Henry
- Polyclinique Essey-les-Nancy, UCCI, France.
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40
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Abstract
Stenting for subclavian artery occlusive disease is being increasingly utilized. To determine the immediate and late outcome of subclavian artery stenting, we studied 38 consecutive patients in whom the procedure was attempted. Technical and clinical success was achieved in 35 patients without complications. Failures occurred only in completely occluded arteries. Late clinical success was demonstrated in 31 patients. Three patients had recurrent symptoms. Two had angiographic restenosis within 4 months of the procedure; both were successfully redilated. The third patient had a new lesion, which was successfully stented. One patient died from lung cancer 10 months after the procedure. We conclude that stenting for subclavian artery occlusive disease has favorable immediate and late clinical outcomes and may be considered as a primary therapy.
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Affiliation(s)
- N Al-Mubarak
- Interventional Cardiology, Division of Cardiovascular Diseases, University of Alabama at Birmingham, 35294, USA
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41
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Sullivan TM, Gray BH, Bacharach JM, Perl J, Childs MB, Modzelewski L, Beven EG. Angioplasty and primary stenting of the subclavian, innominate, and common carotid arteries in 83 patients. J Vasc Surg 1998; 28:1059-65. [PMID: 9845657 DOI: 10.1016/s0741-5214(98)70032-1] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The initial and long-term results of angioplasty and primary stenting for the treatment of occlusive lesions involving the supra-aortic trunks were studied. METHODS All patients in whom angioplasty and stenting of the supra-aortic trunks was attempted were included in a prospective registry. Results are, therefore, reported on an intent-to-treat basis. The preprocedural and postprocedural clinical records, arteriograms, and noninvasive vascular laboratory examinations of 83 patients (41 men [49.4%] and 42 women [50.6%]; mean age at intervention, 63 years) in whom endovascular repair of the subclavian (66, 75.9%), left common carotid (14, 16.1%), and innominate (7, 8.0%) arteries was attempted were retrospectively reviewed. RESULTS Initial technical success was achieved in 82 of 87 procedures (94.3%). The inability to cross 4 complete subclavian occlusions and the iatrogenic dissection of 1 common carotid artery lesion accounted for the 5 initial failures. Complications occurred in 17.8% of 73 subclavian and innominate procedures, including access-site bleeding in 6 and distal embolization in 2. Ischemic strokes occurred in 2 of 14 common carotid interventions (14.3%), both of which were performed in conjunction with ipsilateral carotid bifurcation endarterectomy. The 30-day mortality rate was 4.8% for the entire group. By means of life-table analysis, 84% of the subclavian and innominate interventions, including initial failures, remain patent by objective means at 35 months. No patients have required reintervention or surgical conversion for recurrence of symptoms. Of the 11 patients available for follow-up study who underwent common carotid interventions, 10 remain stroke-free at a mean of 14.3 months. CONCLUSION Angioplasty and primary stenting of the subclavian and innominate arteries can be performed with relative safety and expectations of satisfactory midterm success. Endovascular repair of common carotid artery lesions can be performed with a high degree of technical success, but should be approached with caution when performed in conjunction with ipsilateral bifurcation endarterectomy.
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Affiliation(s)
- T M Sullivan
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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ROCHA-SINGH KRISHNAJ. Update on Lower Extremity Endovascular Interventions. J Interv Cardiol 1998. [DOI: 10.1111/j.1540-8183.1998.tb00192.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ruebben A, Tettoni S, Muratore P, Rossato D, Savio D, Conforti M, Nessi F, Rabbia C. Feasibility of intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk. J Thorac Cardiovasc Surg 1998; 115:1316-20. [PMID: 9628673 DOI: 10.1016/s0022-5223(98)70214-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We sought to evaluate the feasibility and results of intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk. PATIENTS AND METHODS Between May 1993 and October 1996, we treated eight patients with local stenosis of the innominate artery. Seven lesions were situated in the proximal and one in the middle third of the brachiocephalic trunk. Five patients were men and three were women, with ages ranging from 55 to 72 years (mean 59.5 years). All stenoses provoked severe blood flow reduction and caused clinical symptoms. Procedures were performed in an operating suite with fluoroscopic imaging capabilities. Through an anterolateral cervical approach the right common carotid artery was surgically exposed and then clamped to avoid atheroembolization during the subsequent procedure. Retrograde catheterization was performed to reach the stenosis of the brachiocephalic trunk. The lesion was dilated with a balloon catheter and successively stented. Follow-up examinations (color-coded duplex sonography, accompanied by clinical inspection and systolic blood pressure) were scheduled every 6 months. RESULTS In all patients the dilation of the stenosis of the innominate artery and the stent placement were successful without any side effects. No embolic events or other complications occurred. The postintervention angiography showed successfully dilated stenoses and patent stents in all cases. The technical success rate was 100%. CONCLUSIONS On the basis of our preliminary data, we believe that, in selected patients, intraoperative balloon angioplasty of stenosis of the innominate artery with stent placement from the right common carotid artery approach is a safe and effective alternative to conventional operations.
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Affiliation(s)
- A Ruebben
- Radiologia del Pronto Soccorso, Azienda Ospedaliera San Giovanni Battista, Torino, Italy
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Rabah MM, Gangadharan V, Brodsky M, Safian RD. Unstable coronary ischemic syndromes caused by coronary-subclavian steal. Am Heart J 1996; 131:374-8. [PMID: 8579036 DOI: 10.1016/s0002-8703(96)90369-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M M Rabah
- Department of Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA
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Watura R, Halpin SF, Ruttley MS. Percutaneous transluminal angioplasty of an innominate artery occlusion. Cardiovasc Intervent Radiol 1995; 18:396-8. [PMID: 8591627 DOI: 10.1007/bf00338308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A middle-aged woman presented with recent-onset left hemiparesis and right subclavian steal syndrome. She was found to have an obstructed innominate artery. We successfully performed balloon angioplasty of the occluded innominate artery and encountered no complications during follow-up of currently 8 months.
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Affiliation(s)
- R Watura
- Department of Radiology, University Hospital of Wales, Health Park, Cardiff, United Kingdom
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Hinchcliffe M, Ruttley MS, Carolan-Rees G. Case report: percutaneous transluminal angioplasty of irradiation induced bilateral subclavian artery occlusions. Clin Radiol 1995; 50:804-7. [PMID: 7489637 DOI: 10.1016/s0009-9260(05)83227-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M Hinchcliffe
- Department of Radiology, University Hospital of Wales, Heath Park, Cardiff, UK
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Kumar K, Dorros G, Bates MC, Palmer L, Mathiak L, Dufek C. Primary stent deployment in occlusive subclavian artery disease. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 34:281-5. [PMID: 7621536 DOI: 10.1002/ccd.1810340202] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Primary (without antecedent balloon dilation) Palmaz stent implantation was successfully performed in 27 consecutive patients entering with 31 obstructed subclavian arteries. Stents (n = 50) were successfully deployed, using the brachial (n = 7), femoral (n = 16), or combined (n = 8) approach, to revascularize 31 subclavian vessels [8 occluded (26%); 23 stenotic (74%)], using a 6 or 7.5 French delivery system. The indications for intervention were arm claudication in 8 patients (30%), subclavian steal syndrome in 11 patients (41%), angina pectoris secondary to impaired blood flow to the left internal mammary artery coronary bypass in 6 patients (22%), and recanalization of a left subclavian occlusion to permit central arterial access and performance of a second interventional procedure 2 patients (7%). The percent diameter stenosis improved from 85 +/- 12% to 6 +/- 7% (P < 0.001); and, the peak and mean translesion gradients decreased, respectively, from 56 +/- 35 mm Hg to 3 +/- 4 mm Hg (P < 0.01), and 29 +/- 18 mm Hg to 2 +/- 2 mm Hg (P < 0.01). Procedural complications encountered were one stent dislodgement with migration into and uneventful deployment within the right external iliac artery, and two brachial artery repairs. No acute vessel closures, deaths, myocardial infarctions, cerebrovascular accidents, transient ischemic attacks, or need for transfusions occurred. Therefore, primary subclavian artery stent deployment can be performed using low-profile sheath systems with excellent success (100%), resulting in immediate restoration of pulsatile flow, and few complications. The incidence of lesion recurrence remains for follow-up studies.
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Affiliation(s)
- K Kumar
- William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation, Ltd., Mulwaukee, WI 53215, USA
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Diethrich EB, Cozacov JC. Subclavian stent implantation to alleviate coronary steal through a patent internal mammary artery graft. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1995; 2:77-80. [PMID: 9234121 DOI: 10.1583/1074-6218(1995)002<0077:ssitac>2.0.co;2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Interventional techniques are rapidly supplanting conventional surgical therapies for the treatment of brachiocephalic occlusive disease. Although coronary-subclavian steal has been successfully alleviated with subclavian angioplasty, we report the first use of a Palmaz stent in the left subclavian artery (SCA) of a patient with a compromised left internal mammary artery (IMA) graft. METHODS AND RESULTS A 65-year old male patient had undergone triple coronary artery bypass grafting in 1992, but 6 months later, severe narrowing occurred in two of the saphenous vein grafts, and arteriography identified a high-grade stenosis in the SCA supplying the left IMA graft to the left anterior descending coronary artery. Following balloon dilation of one saphenous vein graft stenosis, the left SCA was stented primarily with a P3008 Palmaz stent. Normal hemodynamics were restored, and the patient has been free of coronary steal symptoms for over 1 year. CONCLUSION This case illustrates yet another aspect to the usefulness of intravascular stents in restoring and maintaining inflow to bypass grafts.
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Affiliation(s)
- E B Diethrich
- Department of Cardiovascular Surgery, Arizona Heart Institute & Foundation, Phoenix 85006, USA
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Abstract
The internal mammary artery (IMA) is the conduit of choice for cardiac revascularization. The phenomenon of retrograde flow in this graft secondary to proximal subclavian artery stenosis is an infrequent but increasingly recognized clinical entity and has been termed the "coronary-subclavian steal syndrome." We report on five patients with this syndrome. All were men. The average age was 65 years (range 56 to 68 years). The mean interval from coronary bypass to presentation was 7.8 years (range 1 month to 18 years). Three patients presented with unstable angina and one with congestive heart failure. One patient was asymptomatic from a cardiac standpoint. The mean arm systolic blood pressure differential was 45 mm Hg (range 30 to 60 mm Hg). Each patient underwent cardiac catheterization, and retrograde IMA flow was demonstrated in 100%. Arteriography confirmed the presence of a proximal high-grade (> 75%) subclavian stenosis in all patients. Stress thallium scanning was performed in two patients and demonstrated anterolateral ischemia in both. Operative intervention in four patients consisted of a left carotid-subclavian bypass using an 8 mm synthetic graft. There was no perioperative morbidity or mortality. Postoperative thallium scanning revealed resolution of the ischemic process. The average length of follow-up was 20 months (range 12 to 25 months) with all patients remaining asymptomatic. The one patient who refused surgery died at 12 months. When IMA grafting is contemplated, proximal subclavian stenosis should be suspected if there is > 20 mm Hg systolic pressure differential between the arms.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F C Bryan
- Department of Surgery, Emory University School of Medicine, Atlanta, Ga., USA
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Stagg SJ, Abben RP, Chaisson GA, Kowalski JM, Ladd WR, Meldahl RV, Manalo EP, Walker CM. Management of the coronary-subclavian steal syndrome with balloon angioplasty. A case report and review of the literature. Angiology 1994; 45:725-31. [PMID: 8048782 DOI: 10.1177/000331979404500808] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A fifty-two-year-old woman with angina pectoris due to coronary-subclavian steal syndrome through a left internal mammary artery graft placed distal to a left anterior descending artery stenosis is presented. Retrograde flow through the mammary artery graft due to severe left subclavian stenosis was observed angiographically. Accordingly, left subclavian balloon angioplasty was performed, restoring normal antegrade flow through the internal mammary artery graft and resulting in resolution of the patient's symptoms. The patient was subsequently discharged with no evidence of angina. Carotid-subclavian bypass surgery was avoided, reducing patient discomfort, procedural risk, and expense.
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Affiliation(s)
- S J Stagg
- Cardiovascular Institute of the South Houma Heart Center, LA 70361-4176
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