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Barkyoumb D, Kharbat AF, Orenday-Barraza JM, Pahuja M, Shakir HJ. Transradial stenting of left subclavian artery origin using shockwave intravascular lithotripsy balloon plasty: Technical report and literature review. Interv Neuroradiol 2024:15910199241260076. [PMID: 38853685 DOI: 10.1177/15910199241260076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Lesions of the subclavian artery often involve pathologic stenosis due to high degrees of calcification within the vessel wall. While endovascular angioplasty and stenting is generally the preferred method for obtaining flow reconstitution, calcification of the vessel wall has proven to significantly impair the efficacy of successful stent deployment. Shockwave intravascular lithotripsy (IVL) is a technology that has been very successful in addressing this challenge in other vascular territories, however its use has yet to be approved for supra-aortic vessels such as the subclavian artery. In this report, the use of IVL for a case of subclavian steal syndrome due to a highly stenosed left subclavian artery is described along with a review of the literature. Although several cases utilizing this technology in subclavian arteries have been reported, none have described the use of a left transradial approach. Therefore the purpose of this report is to demonstrate the efficacy of IVL for supra-aortic vessels so that its benefits can be expanded to a broader patient population.
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Affiliation(s)
- David Barkyoumb
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Abdurrahman F Kharbat
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Mohit Pahuja
- Section of Cardiovascular Diseases, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hakeem J Shakir
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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2
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Wenkel M, Halloum N, Izzat MB, Ali-Hasan-Al-Saegh S, Duerr GD, Kriege M, Stamenovic D, Treede H, El Beyrouti H. Long-Term Outcome of Carotid-Subclavian Bypass in the Management of Coronary-Subclavian Steal Syndrome. Vasc Endovascular Surg 2024; 58:29-33. [PMID: 37366167 DOI: 10.1177/15385744231186272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The presence of a significant left subclavian artery stenosis may occasionally lead to blood flow reversal through a LIMA-to-coronary artery bypass graft during left arm exertion; with "stealing" of myocardial blood supply. The aim of this study was to review our experience with carotid-subclavian bypass in patients with post-CABG coronary-subclavian steal syndrome. METHODS This is a retrospective review of all patients who underwent carotid-subclavian bypass grafting for post-CABG coronary-subclavian steal syndrome at Mainz University Hospital between 2006 and 2015. Cases were identified in our institutional database, and data were retrieved from surgical records, imaging studies, and follow-up records. RESULTS Nine patients (all males, mean age of 69.1 years) underwent surgical treatment for post-CABG coronary-subclavian steal syndrome. Medium interval between original CABG and carotid-subclavian bypass grafting was 86.1 months. There were no perioperative deaths, strokes or myocardial infarctions. At a mean follow-up period of 79.9 months, all patients remained asymptomatic and all carotid-subclavian bypass grafts remained patent. One patient required stenting of a common carotid artery stenosis proximal to the graft anastomosis site, and coronary artery stenting was required in four patients in regions other than those supplied by the patent LIMA graft. CONCLUSION Carotid-subclavian bypass surgery is a safe treatment option even in patients with multivessel disease and severe comorbidities and should be taken into consideration in patients who are deemed fit for surgery and those who would benefit from the excellent long-term patency rates.
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Affiliation(s)
- Martin Wenkel
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Nancy Halloum
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | | | - Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Georg Daniel Duerr
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Hazem El Beyrouti
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
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3
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Beloyartsev DF, Adyrkhaev ZA, Fagamov RR. [Treatment of atherosclerotic lesion of the first segment of subclavian artery]. Khirurgiia (Mosk) 2023:95-102. [PMID: 38088846 DOI: 10.17116/hirurgia202312195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Severe subclavian artery lesion is an important medical and social problem worsening the quality of life and leading to dire consequences. Vertebrobasilar insufficiency is the main syndrome of lesion of the first segment of subclavian artery. About 20% of all ischemic strokes occur in vertebrobasilar basin. At present, surgical treatment of asymptomatic patients with severe lesion of the 1st segment of subclavian artery is still debatable. Open surgery is optimal for occlusion of this vascular segment. Carotid-subclavian transposition is a preferable option with favorable in-hospital and long-term results. However, carotid-subclavian bypass is an equivalent alternative in case of difficult transposition following anatomical and topographic features of vascular architectonics. Endovascular treatment is preferable for isolated subclavian artery stenosis and should certainly include stenting.
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Affiliation(s)
- D F Beloyartsev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Z A Adyrkhaev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - R R Fagamov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Miyoshi K, Akamatsu Y, Kojima D, Yoshida J, Ogasawara Y, Kashimura H, Kubo Y, Ogasawara K. Balloon-hooking technique for stabilizing a guiding catheter in tortuous supra-aortic vessel: A case report. Radiol Case Rep 2022; 17:3966-3970. [PMID: 35991386 PMCID: PMC9388873 DOI: 10.1016/j.radcr.2022.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/17/2022] [Accepted: 07/23/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: When performing endovascular interventions for supra-aortic vessels, the tortuous vascular anatomy observed in patients with atherosclerotic lesions often limits the ability to maintain a stable guiding catheter position. Here, we report a case of right vertebral artery (VA) stenosis treated with transfemoral stenting and discuss the utility of balloon-hooking technique using partially inflated balloon for stabilizing the balloon guiding catheter (BCG) in the supra-aortic vessel. Case presentation: A 74-year-old man who underwent right carotid artery stenting, coronary artery bypass grafting, and bilateral iliac artery stenting was admitted to our emergency department because of dizziness related to head movement. Computed tomography angiography revealed right VA origin stenosis and left subclavian artery (SA) occlusion. The patient underwent stenting of the right VA. After several unsuccessful cannulation attempts into the right VA through transradial access, transfemoral access was obtained through the left iliac stent. A 9-Fr BGC was navigated into the right SA. The balloon was partially inflated just distal to the first curve of the right SA and used as hook by pulling back until the proximal edge of the balloon was pushed distally by the lesser curvature of the SA, resulting in stabilization of the BGC and successful angioplasty and stent deployment at the VA stenosis. The patient's symptoms resolved completely, without any neurological deficits. Conclusions: Balloon-hooking technique using a partially inflated BGC is feasible for stabilizing the guiding catheter in tortuous supra-aortic vessel.
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Affiliation(s)
- Kenya Miyoshi
- Department of Neurosurgery, Iwate Medical University School of Medicine, 2-1-1 Yahaba, Iwate, 028-3694, Japan
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Yosuke Akamatsu
- Department of Neurosurgery, Iwate Medical University School of Medicine, 2-1-1 Yahaba, Iwate, 028-3694, Japan
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
- Corresponding author.
| | - Daigo Kojima
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Jun Yoshida
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Yasushi Ogasawara
- Department of Neurosurgery, Iwate Medical University School of Medicine, 2-1-1 Yahaba, Iwate, 028-3694, Japan
| | - Hiroshi Kashimura
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University School of Medicine, 2-1-1 Yahaba, Iwate, 028-3694, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University School of Medicine, 2-1-1 Yahaba, Iwate, 028-3694, Japan
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El Bhali H, Bounssir A, Bakkali T, Jdar A, El Khloufi S, Lekehal B. Symptomatic subclavian steal syndrome: Report of four Moroccan cases and literature review. Int J Surg Case Rep 2021; 85:106173. [PMID: 34284339 PMCID: PMC8318908 DOI: 10.1016/j.ijscr.2021.106173] [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] [Received: 03/24/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Subclavian steal syndrome (SSS) is the hemodynamic phenomenon of blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal ipsilateral subclavian artery. Materials and methods Four patients with subclavian steal syndrome were treated in our center. Percutaneous radial approach was used for angioplasty, primary stenting of subclavian artery was performed, surgical techniques in particular carotid-subclavian bypass and carotid-subclavian transposition were used. Results We report the cases of four patients, three of which are male, with an average age of 60 years. All of them were symptomatic. Diagnosis was made by duplex ultrasound, supplemented by CT-angiography and arteriography. Endovascular treatment was attempted in all four patients, which was successful in two patients, who underwent primary stenting, and failed for the two others, for whom surgical treatment was considered. One had a subclavio-carotid bypass graft with a polytetrafluorethylene (PTFE) prosthesis and the other had a subclavio-carotid transposition. The technical results were satisfactory in all patients with symptoms resolution. The postoperative evolution was without notable complications and the postoperative checkups were satisfactory. Discussion There are excellent screening tools and effective medical therapies which can be instituted if the SSS is diagnosed early. When the need for revascularization arises, percutaneous modalities are favored given their proven long-term efficacy, decreased morbidity and mortality, and cost-effectiveness. Nevertheless, large, prospective, randomized and controlled trials are needed to compare the long-term patency rates between the endovascular and surgical techniques. SSS is caused by the reversal of blood flow in the vertebral artery. Doppler ultrasound is the ultimate screening tool for diagnosis. Treatment of symptomatic SSS is always indicated. Endovascular approach is the first-line treatment.
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Affiliation(s)
- Hajar El Bhali
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco.
| | - Ayoub Bounssir
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco
| | - Tarik Bakkali
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco
| | - Asmae Jdar
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco
| | - Samir El Khloufi
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco
| | - Brahim Lekehal
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco
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Huang CC, Huang WM, Jhou ZY, Chen JH, Chen ST, Lin HC, Huang CY, Chen CH, Luo CB, Chang FC. Angioplasty and stenting for symptomatic stenosis of the left subclavian artery complicated with aortic dissection. J Chin Med Assoc 2021; 84:273-279. [PMID: 33496512 DOI: 10.1097/jcma.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Aortic dissection is a rare but severe complication of percutaneous transluminal angioplasty and stenting (PTAS) for stenosis of the subclavian artery (SA). This retrospective study was designed to evaluate the risk factors and outcomes of patients with severe stenosis of the SA who underwent PTAS complicated by aortic dissection. METHODS Between 1999 and 2018, 169 cases of severe symptomatic stenosis of the SA underwent PTAS at our institute. Of them, six cases complicated by aortic dissection were included in this study. We evaluated the demographic features, technical factors of PTAS, and clinical outcomes in these six patients. RESULTS Aortic dissection occurred in 5.3% (6/113) of all left SA stenting cases but in none of the right SA stenting cases. All patients had hypertension and a high severity of SA stenosis (85.0 ± 13.0%, 60%-95%). Five of the six patients received balloon-expandable stents (83.3%). All patients had spontaneous resolution of the aortic dissection with conservative treatment. In a 63.33 ± 33.07 (7-118) month follow-up, five of the six patients (83.3%) had long-term symptom relief and stent patency. CONCLUSION Aortic dissection occurred in patients who underwent PTAS for severe stenosis of the left SA, mainly with balloon-expandable stents. We suggest using self-expandable stents and angioplasty with an undersized balloon during PTAS for severe stenosis of the left proximal SA to prevent aortic dissection.
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Affiliation(s)
- Chun-Chao Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
| | - Wei-Ming Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Zong-Yi Jhou
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Jung-Hsuan Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shu-Ting Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hui-Chen Lin
- Department of Radiology, Sinying Hospital, Ministry of Health and Welfare, Tainan, Taiwan, ROC
| | - Chung-Yao Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Chia-Hung Chen
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Qi Y, Li L, Cui S, Yan L, Gu Y. Simultaneous Axillary–Carotid and Carotid–Axillary Bypass. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02325-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Fakih R, Dandapat S, Mendez-Ruiz A, Mendez AA, Farooqui M, Zevallos C, Quispe Orozco D, Hasan D, Rossen J, Samaniego EA, Derdeyn C, Ortega-Gutierrez S. Combined Transradial and Transfemoral Approach With Ostial Vertebral Balloon Protection for the Treatment of Patients With Subclavian Steal Syndrome. Front Neurol 2020; 11:576383. [PMID: 33193028 PMCID: PMC7642489 DOI: 10.3389/fneur.2020.576383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Patients with an obstructive subclavian artery (SA) may exhibit symptoms of vertebrobasilar insufficiency known as subclavian steal syndrome (SSS). Endovascular treatment with stent assisted percutaneous transluminal angioplasty (SAPTA) demonstrates significantly lower percentage of intraoperative and postoperative complications in comparison with open surgery. There is a 1–5% risk of distal intracranial embolization through the ipsilateral vertebral artery (VA) during SAPTA. Objective: To assess the safety and feasibility of a novel technique for distal embolic protection using balloon catheters during SA revascularization with a dual transfemoral and transradial access. Methods: We describe a case series of patients with SSS who underwent SAPTA due to severe stenosis or occlusion of the SA using a combined anterograde/retrograde approach. Transfemoral access to SA was obtained using large bore guide sheaths. Ipsilateral transradial access was obtained using intermediate bore catheters. A Scepter XC balloon catheter was introduced through the transradial intermediate catheter into the ipsilateral VA at the ostium during SAPTA for distal embolic protection. Results: A total of eight patients with SSS underwent subclavian SAPTA. Four patients had the combined anterograde/retrograde approach. Successful revascularization was achieved in three of them. It was difficult to create a channel in the fourth unsuccessful case due to heavily calcified plaque burden. No peri-operative ischemic events were identified. On follow-up, we demonstrated patency of the stents with resolution of symptoms and without any adverse events. Conclusion: Subclavian stenting using a combined transradial and transfemoral access with compliant balloon catheters at the vertebral ostium for prevention of distal emboli may represent an alternative therapeutic approach for the treatment of SA stenosis and occlusions.
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Affiliation(s)
- Rami Fakih
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Alan Mendez-Ruiz
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Aldo A Mendez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Cynthia Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Darko Quispe Orozco
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - David Hasan
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - James Rossen
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Internal Medicine-Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Colin Derdeyn
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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9
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AbuRahma AF, Lee A, Davis E, Dean LS. Safety and durability of concomitant carotid endarterectomy with carotid-subclavian bypass grafting. J Vasc Surg 2020; 73:968-974. [PMID: 32361068 DOI: 10.1016/j.jvs.2020.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Concomitant carotid endarterectomy (CEA; for severe internal carotid artery stenosis) with carotid-subclavian bypass grafting (CSBG; for proximal common carotid artery or subclavian artery occlusion) is rarely used. Only a few studies have been reported. This report analyzed early and late clinical outcomes of the largest study to date of the combined procedures in our institution. METHODS Electronic medical records of patients who had concomitant CEA with CSBG during three decades were analyzed. Indications for surgery were arm ischemia, neurologic events, and clinical subclavian steal. Early (30 days) perioperative complications (stroke, death, and others) and late complications (stroke, death) were recorded. Kaplan-Meier analysis was used to estimate late graft/CEA primary patency, freedom from stroke, and stroke-free survival rates. Graft patency was determined clinically and confirmed using duplex ultrasound. Outcomes were compared with previously published data on isolated CSBG by the same group. RESULTS There were 37 combined procedures analyzed. Mean age was 64 years (range, 45-81 years). Indications for surgery were arm ischemia in 12 (32%), hemispheric transient ischemic attack or stroke in 15 (41%), vertebrobasilar insufficiency in 4 (11%), symptomatic subclavian steal in 10 (27%), and asymptomatic common carotid artery occlusion with severe internal carotid artery stenosis in 6 (16%). The 30-day perioperative (stroke and death) rate was 5.4% (one stroke and one death). Immediate symptom relief was noted in 100%, with 2.7% (transient ischemic attack) symptom recurrence. The crude patency rate of both CEA and CSBG was 92%. At 1 year, 2 years, 3 years, 4 years, and 5 years, respectively, primary patency rates were 100%, 96%, 96%, 96%, and 85%; freedom from stroke rates were 97%, 97%, 97%, 97%, and 97%; and stroke-free survival rates were 94%, 94%, 87%, 82%, and 78%. When these outcomes were compared with the isolated CSBG group alone (28 patients), there was no difference in perioperative stroke (2.7% for concomitant CEA/CSBG vs 0% for isolated CSBG), perioperative death (2.7% vs 2.8%), or late patency rates (92% vs 96%). CONCLUSIONS Concomitant CEA/CSBG is safe and durable. There was no significant difference in perioperative stroke/death or late patency rates compared with isolated CSBG.
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Affiliation(s)
- Ali F AbuRahma
- Department of Surgery, West Virginia University, Charleston, WV.
| | - Andrew Lee
- Department of Surgery, West Virginia University, Charleston, WV
| | - Elaine Davis
- CAMC Health Education and Research Institute, Charleston, WV
| | - L Scott Dean
- CAMC Health Education and Research Institute, Charleston, WV
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10
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Schneider V, Dirschinger R, Wustrow I, Müller A, Cassese S, Fusaro M, Kastrati A, Koppara T, Bergmann K, Laugwitz KL, Ibrahim T, Bradaric C. Endovascular therapy of subclavian artery occlusive disease involving the vertebral artery origin. VASA 2020; 49:205-213. [PMID: 31904303 DOI: 10.1024/0301-1526/a000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: While the majority of subclavian artery (SA) lesions are localized in the proximal segment, the evidence in patients with medial SA disease involving the vertebral artery (VA) origin are scarce. PATIENTS AND METHODS We retrospectively analyzed all patients who underwent percutaneous revascularization of the SA at our institution. RESULTS A total of 196 patients were retrospectively analyzed. The majority of SA lesions (n = 163, 83 %) were located in the proximal segment, whereas 28 lesions (14 %) were located in the medial segment, and only 5 lesions (3 %) involved the distal segment. Procedural success was high for both stenosis (96 %) and occlusion (89 %) and did not differ depending on lesion location. Revascularization techniques in the medial segment included stenting of the SA only (13 patients), additional VA balloon-dilatation (6 patients), and bifurcation stenting of the SA and VA using T-stenting technique (9 patients). Outcome after a median of 12 months showed no significant differences in freedom from restenosis between proximal and medial lesions (90 % vs. 95 %; p = 0.67). CONCLUSIONS Endovascular revascularization of SA disease with medial segments involving the VA origin required more complex techniques and showed long-term patency rates comparable to those in lesions located within the proximal SA.
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Affiliation(s)
- Vera Schneider
- Medizinische Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ralf Dirschinger
- Medizinische Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Isabel Wustrow
- Medizinische Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Arne Müller
- Medizinische Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tobias Koppara
- Medizinische Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Katharina Bergmann
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Medizinische Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tareq Ibrahim
- Medizinische Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Bradaric
- Medizinische Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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11
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Subclavian steal syndrome: A forgotten aetiology of acute cerebral ischaemia. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Benhammamia M, Mazzaccaro D, Ben Mrad M, Denguir R, Nano G. Endovascular and Surgical Management of Subclavian Artery Occlusive Disease: Early and Long-Term Outcomes. Ann Vasc Surg 2019; 66:462-469. [PMID: 31863950 DOI: 10.1016/j.avsg.2019.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The aim of the study was to report early and late outcomes of surgical and endovascular management of subclavian artery atherosclerotic disease (SAAD). METHODS Data about consecutive patients treated for subclavian artery atherosclerotic occlusive disease between 2001 and 2018 either by open surgical repair (OSR) or by endovascular repair (ER) were retrospectively collected and analyzed. Primary outcomes included 30-day death, as well as cardiac and neurologic events, reported separately for occlusion and stenosis. Secondary outcomes included primary patency in the long term, reported separately for occlusive and stenotic lesions. The Kaplan-Meier analysis with the logrank test was used to estimate long-term primary patency. Chi-squared and t-tests were used as appropriate to compare the outcomes of the 2 groups. A P value < 0.05 was considered statistically significant. RESULTS Sixty-eight patients were treated using ER (49 patients) and OSR (19). Technical success rate was 100% in both groups. During in-hospital stay, 1 brachial hematoma and 2 acute upper limb ischemia occurred in the ER group and in the OSR group, respectively. At 30 days, no deaths or neurological/cardiac events were recorded in both ER and OSR groups. Symptoms resolution and upper limb salvage were 100% in both groups. In the ER group, primary patency was 100% at 7 years in patients who had been treated for stenotic lesions and 62.5 ± 21.3% in patients who had been treated for occlusive lesions (P = 0.0035). In the OSR group, primary patency was 100% at 7 years in patients treated for stenotic lesions and 25 ± 21.6% in patients who had been treated for occlusive lesions (P < 0.0001). Overall, long-term primary patency in the OSR group was 76.9 ± 11.7% at 7 years, being lower than that reported after ER (93.4 ± 4.5%, P = 0.02). CONCLUSIONS Both ER and OSR proved to be safe, effective, and durable in the treatment of SAAD. In particular, the primary patency rates at long term for both ER and OSR showed better outcomes for stenotic lesions.
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Affiliation(s)
- Mohamed Benhammamia
- Cardiovascular Surgery Department of La Rabta University Hospital, Tunis, Tunisia
| | - Daniela Mazzaccaro
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - Malek Ben Mrad
- Cardiovascular Surgery Department of La Rabta University Hospital, Tunis, Tunisia
| | - Raouf Denguir
- Cardiovascular Surgery Department of La Rabta University Hospital, Tunis, Tunisia
| | - Giovanni Nano
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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13
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Onishi H, Naganuma T, Hozawa K, Sato T, Ishiguro H, Tahara S, Kurita N, Nakamura S, Nakamura S. Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease. Vasc Endovascular Surg 2019; 53:284-291. [PMID: 30696371 DOI: 10.1177/1538574418824444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. MATERIAL AND METHODS We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. RESULTS There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). CONCLUSION Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.
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Affiliation(s)
- Hirokazu Onishi
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Koji Hozawa
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Tomohiko Sato
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Satoko Tahara
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Naoyuki Kurita
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Sunao Nakamura
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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14
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Galyfos GC, Kakisis I, Maltezos C, Geroulakos G. Open versus endovascular treatment of subclavian artery atherosclerotic disease. J Vasc Surg 2019; 69:269-279.e7. [DOI: 10.1016/j.jvs.2018.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
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15
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Rafailidis V, Li X, Chryssogonidis I, Rengier F, Rajiah P, Wieker CM, Kalva S, Ganguli S, Partovi S. Multimodality Imaging and Endovascular Treatment Options of Subclavian Steal Syndrome. Can Assoc Radiol J 2018; 69:493-507. [DOI: 10.1016/j.carj.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/20/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Vasileios Rafailidis
- AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xin Li
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ioannis Chryssogonidis
- AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fabian Rengier
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Prabhakar Rajiah
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Carola M. Wieker
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sanjeeva Kalva
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Suvranu Ganguli
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sasan Partovi
- Section of Interventional Radiology, Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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16
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Usai MV, Bosiers MJ, Bisdas T, Torsello G, Beropoulis E, Kasprzak B, Stachmann A, Stavroulakis K. Surgical versus endovascular revascularization of subclavian artery arteriosclerotic disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 61:53-59. [PMID: 29786405 DOI: 10.23736/s0021-9509.18.10144-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Endovascular treatment offers an alternative, less invasive approach to open repair for subclavian artery atherosclerotic disease (SAAD). However, only few studies compared the outcomes of both strategies in the long run. This study reports on the performance of endovascular and surgical revascularization for SAAD. METHODS A retrospective review was conducted on patients treated for SAAD at two institutions between January 1998 and December 2015. Primary outcome of this study was the composite endpoint of reintervention-free survival (RFS) defined as time to reintervention and/or death from any cause. Secondary endpoints included primary patency (PPR) and secondary patency (SPR) rates as well as overall survival and time to reintervention. RESULTS Surgical treatment was the preferred treatment option in 27 (25%) patients, while 83 (75%) patients underwent primary stent therapy. The median follow-up was 87 months (interquartile range [IQR]: 38 to 151) in the surgical group and 27 (IQR: 12 to 59) in the endovascular (P=0.0001). Severe arterial wall calcification was more commonly observed in the surgical arm (P<0.0001), while mild and moderate calcification in the endovascular (P=0.0004 and P=0.014). Vessel occlusion was more frequent among patients treated surgically (100% vs. 34%, P<0.0001). At 98 months RFS was significantly higher after surgical treatment (95% vs. 54%, HR: 8.4, 95% CI: 3.9 to 18.1, P=0.0002). Although overall survival did not differ significantly between the two groups (HR: 4.28, 95% CI: 0.86 to 21.22, P=0.093), open repair was associated with reduced reintervention rate (HR: 12.04, 95% CI: 4.98 to 29.12, P=0.001). The PPR at 98 months following surgical and endovascular therapy amounted to 96% and 65% (HR: 12.87, 95% CI: 5.44 to 30.44, P=0.0008) respectively. No significant difference was observed regarding the SPR between the two groups (100% vs. 95%, P=0.090). CONCLUSIONS Surgical treatment was associated in this cohort with increased patency and a significant reduction of reinterventions compared to the endovascular approach.
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Affiliation(s)
- Marco V Usai
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany - .,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany -
| | - Michel J Bosiers
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Efthymis Beropoulis
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Bernd Kasprzak
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Arne Stachmann
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Konstantinos Stavroulakis
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
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17
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Al'Aref SJ, Swaminathan RV, Feldman DN. Endovascular therapy of axillary artery disease with drug-coated balloon angioplasty. Proc (Bayl Univ Med Cent) 2017; 30:431-434. [PMID: 28966454 DOI: 10.1080/08998280.2017.11930217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The occurrence of upper-extremity arterial disease is less common than that of the lower extremities. Nevertheless, exercise-induced symptoms, when present, can significantly affect functional capacity and limit quality of life. We report a case of exertional right upper-extremity pain and severe right axillary artery disease that was revascularized using an off-label drug-coated balloon technology with resolution of symptoms.
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Affiliation(s)
- Subhi J Al'Aref
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, New York (Al'Aref); Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina (Swaminathan); and Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York (Feldman)
| | - Rajesh V Swaminathan
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, New York (Al'Aref); Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina (Swaminathan); and Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York (Feldman)
| | - Dmitriy N Feldman
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, New York (Al'Aref); Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina (Swaminathan); and Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York (Feldman)
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18
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Antón Vázquez V, Armario García P, García Sánchez SM, Martí Castillejos C. Subclavian steal syndrome: A forgotten aetiology of acute cerebral ischaemia. Neurologia 2017; 35:65-67. [PMID: 28958397 DOI: 10.1016/j.nrl.2017.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/28/2017] [Accepted: 07/09/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- V Antón Vázquez
- Servicio de Medicina Interna, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España.
| | - P Armario García
- Servicio de Medicina Interna, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - S M García Sánchez
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - C Martí Castillejos
- Área de Riesgo Cardiovascular, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
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19
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Cua B, Mamdani N, Halpin D, Jhamnani S, Jayasuriya S, Mena-Hurtado C. Review of coronary subclavian steal syndrome. J Cardiol 2017; 70:432-437. [PMID: 28416323 DOI: 10.1016/j.jjcc.2017.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/01/2017] [Accepted: 02/17/2017] [Indexed: 11/25/2022]
Abstract
The clinical benefits of using the left internal mammary artery (LIMA) to bypass the left anterior descending artery are well established making it the most frequently used conduit for coronary artery bypass surgery (CABG). Coronary subclavian steal syndrome (CSSS) occurs during left arm exertion when (1) the LIMA is used during bypass surgery and (2) there is a high grade (≥75%) left subclavian artery stenosis or occlusion proximal to the ostia of the LIMA resulting in "stealing" of the myocardial blood supply via retrograde flow up the LIMA graft to maintain left upper extremity perfusion. Although CSSS was once thought to be a rare phenomenon, its prevalence has been underestimated and is becoming increasingly recognized as a serious threat to the success of CABG. Current guidelines are lacking on recommendations for screening of subclavian artery stenosis (SAS) pre- and post-CABG. We hope to provide an algorithm for SAS screening to prevent CSSS in internal mammary artery bypass recipients and review treatment options in the percutaneous era.
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Affiliation(s)
- Bennett Cua
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Natasha Mamdani
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Halpin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Sunny Jhamnani
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Sasanka Jayasuriya
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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20
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Abdul Jabbar A, Houston J, Burket M, Il'Giovine ZJ, Srivastava BK, Agarwal A. Screening for subclinical subclavian artery stenosis before coronary artery bypass grafting: Should we do it? Echocardiography 2017; 34:928-933. [DOI: 10.1111/echo.13528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ali Abdul Jabbar
- Cardiology Division; Department of Internal Medicine; Wright State University Boonshoft School of Medicine; Dayton OH USA
- Division of Cardiovascular Medicine; The University of Toledo College of Medicine and Life Science; Toledo OH USA
- John Ochsner Heart & Vascular Institute; Ochsner Clinic Foundation; New Orleans LA USA
| | - Justin Houston
- Cardiology Division; Department of Internal Medicine; Wright State University Boonshoft School of Medicine; Dayton OH USA
| | - Mark Burket
- Division of Cardiovascular Medicine; The University of Toledo College of Medicine and Life Science; Toledo OH USA
| | - Zachary J. Il'Giovine
- Cardiology Division; Department of Internal Medicine; Wright State University Boonshoft School of Medicine; Dayton OH USA
| | - Bal K. Srivastava
- Cardiology Division; Department of Internal Medicine; Wright State University Boonshoft School of Medicine; Dayton OH USA
| | - Ajay Agarwal
- Cardiology Division; Department of Internal Medicine; Wright State University Boonshoft School of Medicine; Dayton OH USA
- Cardiology Division; Department of Medicine; Dayton VA Medical Center; Dayton OH USA
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21
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Zhang JL, Tong W, Lv JF, Chi LX. Endovascular treatment and morphology typing of chronic ostial occlusion of the subclavian artery. Exp Ther Med 2017; 13:2022-2028. [PMID: 28565803 DOI: 10.3892/etm.2017.4203] [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: 12/11/2015] [Accepted: 01/13/2017] [Indexed: 12/14/2022] Open
Abstract
Chronic obstructive lesions of the subclavian artery (SCA) often result in subclavian steal syndrome, which leads to arm claudication, transient cerebral ischemia, and other serious complications. The lesions are classified as stenosis and occlusion, according to the degree of obstruction. Unlike totally occlusive lesions, including ostial occlusions, stenotic lesions have an excellent technical success rate. In the present study, ostial occlusions were classified into 4 types according to their angiographic appearance. A total of 8 patients (6 male, 2 female) with SCA occlusions were treated with percutaneous transluminal angioplasty and stenting over a 4-year period. Mean patient age was 65.6 years (range, 60-72 years). In total, 9 self-expanding and 1 balloon-expandable stent were implanted at the ostia of the SCA in 7 of the patients. One female patient did not undergo stenting. Bleeding at the access site was noted in 2 patients and was controlled by gauze pressure. The patient that did not undergo stenting was lost to follow-up with symptoms of a transient ischemic attack at 3 months. The mean follow-up time for the remaining 7 patients was 15.7 months (range, 1-36 months). No ischemic symptoms, neointimal hyperplasia, or restenosis was observed in these patients. The transfemoral artery operation approach is preferred for rat-tail and peak type occlusions, whereas the dual approach involving both femoral and radial arteries is preferred for hilly and plain type occlusions. The angiographic morphology typing used in the present study may serve as a reference to decide upon the interventional operation strategy to be used for improving the technical success rate.
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Affiliation(s)
- Jing-Liang Zhang
- Department of Aerospace Medicine, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China.,Department of Cardiology, Southwest Hospital, The Third Military Medical University, Chongqing 400038, P.R. China
| | - Wei Tong
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Jian-Feng Lv
- Department of Cardiology, Southwest Hospital, The Third Military Medical University, Chongqing 400038, P.R. China
| | - Lu-Xiang Chi
- Department of Cardiology, Southwest Hospital, The Third Military Medical University, Chongqing 400038, P.R. China
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22
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Wang Y, Liu M, Pu C. 2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack. Int J Stroke 2017; 12:302-320. [PMID: 28381199 DOI: 10.1177/1747493017694391] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.
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Affiliation(s)
- Yongjun Wang
- 1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Liu
- 2 Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanqiang Pu
- 3 Department of Neurology, The General Hospital of Chinese People's Liberation Army, Beijing, China
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23
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Karpenko A, Starodubtsev V, Ignatenko P, Gostev A. Endovascular Treatment of the Subclavian Artery Steno-Occlusive Disease. J Stroke Cerebrovasc Dis 2016; 26:87-93. [PMID: 27743924 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of our study was to compare immediate and long-term results of endovascular interventions for the treatment of steno-occlusive disease of subclavian arteries (SAs) depending on the length of lesion. MATERIALS AND METHODS Between 2010 and 2013, we performed 245 endovascular procedures to treat patients with atherosclerotic steno-occlusive disease of SAs. All patients were examined and subdivided according to the received results into 2 groups: 125 patients with stenosis of SA were included in the first group and 120 patients with occlusion of SA were included in the second group. The patients were then followed up at 6, 12, 24, 36, and 48 months after endovascular interventions. Follow-up visits contained symptomatic evaluation, clinical assessment with physical examination, complete neurological evaluation, and serial color Doppler ultrasonography. RESULT Transitory ischemic attacks in the vertebrobasilar system were intraoperatively developed by 1 patient from the first group (.8%) and 3 patients from the second group (2.5%). Reinterventions in the long-term period were carried out in 9 (7.2%) cases in the first group and 12 (10%) cases in the second group (P = .43). The cumulative primary stent patency at 4 years was 89.8% in the first group and 87% in the second group (P = .4). CONCLUSIONS In the case of SA occlusion on the first stage, it is expedient to carry out endovascular recanalization followed by stenting. Our study revealed an increased risk of stent thrombosis or in-stent restenosis in patients with stents >40 mm.
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Affiliation(s)
- Andrey Karpenko
- Academician E.N. Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Ministry for Public Health Care Russian Federation, Novosibirsk, Russian Federation
| | - Vladimir Starodubtsev
- Academician E.N. Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Ministry for Public Health Care Russian Federation, Novosibirsk, Russian Federation.
| | - Pavel Ignatenko
- Academician E.N. Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Ministry for Public Health Care Russian Federation, Novosibirsk, Russian Federation
| | - Alexander Gostev
- Academician E.N. Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Ministry for Public Health Care Russian Federation, Novosibirsk, Russian Federation
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24
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Kedev S, Zafirovska B, Petkoska D, Vasilev I, Bertrand OF. Results of Transradial Subclavian Artery Percutaneous Interventions After Bilateral or Single Access. Am J Cardiol 2016; 118:918-923. [PMID: 27471055 DOI: 10.1016/j.amjcard.2016.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 12/29/2022]
Abstract
Percutaneous treatment of subclavian artery stenosis or occlusion has become more popular compared with surgical correction. We compared the early and late results of subclavian artery stenting with bilateral or single transradial access. From 2010 to 2015, we recruited 54 consecutive patients. In 35 cases, we used bilateral access, and in 19 cases, ipsilateral single access was used. Left subclavian artery was the culprit vessel in 72% of cases. There were more chronic total occlusions in the bilateral group (77% vs 21%, p = 0.0001). Transradial-only approach was used in all cases, except in 2 cases in the bilateral group where crossover to femoral access was required. Stents were implanted in 94% in bilateral group and 84% in single group (p = 0.47). Procedure duration (40 [35 to 60] vs 20 [15 to 30] minutes), contrast volume (200 [200 to 350] vs 150 [100 to 200] ml and fluoroscopy time (20 [12 to 30] vs 8 [4 to 11] minutes) were higher in bilateral group (all p values <0.0001). Procedural success was 96%. Overall, we observed three <5-cm hematomas and 3 asymptomatic radial artery occlusions at hospital discharge. After successful procedure, blood pressure equalized in 94% in bilateral group and 100% in single group (p = 0.54). Major cardiovascular and cerebrovascular event-free survival up to 5 years was 97% in bilateral group compared with 84% in single group (p = 0.12). Subclavian artery patency at late follow-up was 91% in bilateral group and 95% in single group (p = 1.00). Using single or bilateral transradial approach, subclavian artery lesions or occlusions can be effectively and safely treated without the risks of femoral or brachial access.
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Xiao Y, Zhou J, Wei X, Sun Y, Zhang L, Feng J, Feng R, Zhao Z, Jing Z. Outcomes of different treatments on Takayasu's arteritis. J Thorac Dis 2016; 8:2495-2503. [PMID: 27747001 DOI: 10.21037/jtd.2016.08.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Takayasu's arteritis (TA) is a nonspecific chronic inflammation of the aorta and its branches. This study compared the outcomes of surgical treatments including bypass surgery, cutting balloon angioplasty and conventional balloon angioplasty to TA patients exhibiting supra-aortic arterial (SAA). METHODS This retrospective study was conducted on 42 TA patients, obtained from hospital database, who underwent surgical therapy due to SAA lesions from January 2010 to March 2015. Ten patients were reconstructed using cutting balloon angioplasty, 16 patients received conventional balloon angioplasty and 16 patients from bypass surgery. The primary patency, recurrent symptoms, re-intervention, early (<30 days) and late complications associated with treatment were evaluated. RESULTS In the conventional balloon angioplasty group, two patients were converted to bypass surgery as the guidewire could not traverse the lesions. The follow-up at 30.07±17.96 months (range, 1-60 months) showed restenosis or occlusion development in 40.9% arteries in conventional balloon angioplasty, compared with 6.3% after bypass surgery (P=0.018). The restenosis or occlusion rate between cutting balloon angioplasty and conventional balloon angioplasty groups were insignificant (P=0.738). In the re-intervention, three out of four (75%) treated by cutting balloon angioplasty were patent as compared to the three out of nine arteries (33.3%) dealt with by conventional angioplasty that was patent (P=0.266). Intracerebral hemorrhage (n=1) was developed in the bypass surgery group. Mortality was not observed in any of the groups. CONCLUSIONS Cutting balloon angioplasty can be considered as a safe, effective, and less-invasive alternative for non-diffuse SAA lesions, especially in young TA patients. However, bypass surgery has better primary patency rate than endovascular treatment.
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Affiliation(s)
- Yu Xiao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xiaolong Wei
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yudong Sun
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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Liu Y, Zhang J, Gu Y, Guo L, Li J. Clinical Effectiveness of Endovascular Therapy for Total Occlusion of the Subclavian Arteries: A Study of 67 Patients. Ann Vasc Surg 2016; 35:189-96. [DOI: 10.1016/j.avsg.2016.01.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/02/2015] [Accepted: 01/24/2016] [Indexed: 11/25/2022]
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Byrne C, Tawfick W, Hynes N, Sultan S. Ten-year experience in subclavian revascularisation. A parallel comparative observational study. Vascular 2016; 24:378-82. [DOI: 10.1177/1708538115599699] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Subclavian stenosis has a prevalence of approximately 2% in the community, and 7% within a clinical population. It is closely linked with hypertension and smoking. There is a relative paucity of published data to inform clinicians on the optimal mode of treatment for subclavian artery stenosis. Objectives To compare clinical outcomes of subclavian bypass surgery with that of subclavian endovascular re-vascularisation. Endpoints were survival time, re-intervention-free survival, and symptom-free survival. Method In all, 21 subclavian interventions were performed from 2000 to 2010. We compared angioplasty vs angioplasty with stenting vs bypass. Results Technical success was 100% in all groups. Symptom-free survival, at 70 months, was 60% in the angioplasty group, 100% in the angioplasty and stenting group and 75% in the bypass group. Re-intervention rate was 40% in the angioplasty group, 0% in the angioplasty and stenting group and 25% in the bypass group. Median time for re-intervention was 9.5 months in angioplasty patients and 36 months in bypass patients ( p = 0.102). Target lesion revascularisation was 20.0% for angioplasty procedures, 16.67% for angioplasty and stenting and 25% for bypass procedures. Conclusion Angioplasty with stenting provides improved symptom-free survival and freedom from re-intervention in patients with symptomatic subclavian artery stenosis.
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Affiliation(s)
- C Byrne
- Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Republic of Ireland
| | - W Tawfick
- Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Republic of Ireland
| | - N Hynes
- Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Republic of Ireland
- Department of Vascular Surgery, Galway Clinic, Doughiska, Galway, Republic of Ireland
| | - S Sultan
- Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Republic of Ireland
- Department of Vascular Surgery, Galway Clinic, Doughiska, Galway, Republic of Ireland
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Ben Ahmed S, Benezit M, Hazart J, Brouat A, Daniel G, Rosset E. Outcomes of the Endovascular Treatment for the Supra-Aortic Trunks Occlusive Disease: A 14-Year Monocentric Experience. Ann Vasc Surg 2016; 33:55-66. [DOI: 10.1016/j.avsg.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/14/2016] [Accepted: 02/27/2016] [Indexed: 11/15/2022]
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Successful treatment of total occluded innominate artery in a patient with subclavian steal syndrome. Anatol J Cardiol 2016; 16:296-7. [PMID: 27111199 PMCID: PMC5368441 DOI: 10.14744/anatoljcardiol.2016.7008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Salman R, Hornsby J, Wright LJ, Elsaid T, Timmons G, Mudawi A, Bhattacharya V. Treatment of subclavian artery stenosis: A case series. Int J Surg Case Rep 2015; 19:69-74. [PMID: 26722712 PMCID: PMC4756098 DOI: 10.1016/j.ijscr.2015.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/11/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
Case presentation of a patient treated with subclavian artery stenting. Case presentation of a patient treated with transposition of the left subclavian artery onto the left common carotid artery. Case presentation of a patient treated with carotid- subclavian artery bypass with a PTFE graft. Case presentation of a patient treated with carotid to axillary bypass. Discussion and literature review of methods and indications of treatment of subclavian artery occlusive disease.
Introduction In this case series, different modalities of treatment for patients with ischaemic symptoms of subclavian stenosis are described, including the different operative strategies that can be adopted in more challenging cases. This is the first case series describing these four management options. Presentation Case 1: A seventy-one year-old female presented with acute on chronic ischaemia of her left arm following a fall and developed dry gangrene of her left thumb. This was initially managed with a heparin infusion followed by stenting of the subclavian artery which relieved her symptoms. Case 2: A fifty-nine year-old male presented with chronic ischemia of the left arm secondary to an occlusion of the left subclavian artery. This was managed by transposition of the left subclavian artery onto the left common carotid artery. Case 3: A sixty-four year-old female presented with left subclavian steal syndrome secondary to subclavian artery stenosis. She underwent carotid subclavian artery bypass. Case 4: A fifty-six year-old female presented with acute left upper limb ischaemia secondary to acutely thrombosed subclavian artery on a CT-angiography. She underwent a carotid to axillary bypass. Discussion and conclusion This case series demonstrates the treatment options available to vascular surgeons when managing symptomatic subclavian artery disease. Symptomatic subclavian artery occlusive disease should be treated with endovascular stenting and angioplasty as first line management. If it is not successful then open surgery should be considered. Bypassing the carotid to the subclavian or to the axillary artery are both good treatment modalities.
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Affiliation(s)
- Reem Salman
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Jane Hornsby
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Lucie J Wright
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Tarek Elsaid
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Grace Timmons
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Ahmed Mudawi
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Vish Bhattacharya
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
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Ahmed AT, Mohammed K, Chehab M, Brinjikji W, Hassan Murad M, Cloft H, Bjarnason H. Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2015; 39:652-667. [DOI: 10.1007/s00270-015-1250-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/31/2015] [Indexed: 11/27/2022]
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Rahimi SA, Shah N, Labinskyy V, Lee LY. Left Subclavian Artery Revascularization in Preparation for Coronary Artery Bypass Grafting. Cardiology 2015; 133:191-4. [PMID: 26613584 DOI: 10.1159/000441487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/02/2015] [Indexed: 11/19/2022]
Abstract
Coronary subclavian steal syndrome is a rare but important condition that occurs after a left internal mammary artery (LIMA) to coronary artery bypass in the setting of a stenotic left subclavian artery. The lack of blood flow through the subclavian artery causes the reversal of flow in the LIMA so that it essentially steals blood from the myocardium. In order to avoid this complication, many surgeons now opt to either revascularize the stenotic subclavian artery prior to coronary artery bypass grafting or to use an alternate vessel as the bypass graft. Here, we present the case of an asymptomatic patient with poor exercise tolerance who was recently diagnosed with both triple-vessel coronary disease and peripheral arterial disease, which was most notably characterized by occlusion of the left subclavian artery. This case demonstrates the surgical management of this complex clinical entity.
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Affiliation(s)
- Saum A Rahimi
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, N.J., USA
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Ozpak B, Ilhan G. Biosynthetic Versus Polytetrafluoroethylene Graft in Extra-anatomical Bypass Surgery of Takayasu Arteritis Patients With Supra-aortic Disease. J Cardiovasc Thorac Res 2015; 7:101-6. [PMID: 26430497 PMCID: PMC4586595 DOI: 10.15171/jcvtr.2015.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION To evaluate treatment outcomes of patients diagnosed with Takayasu arteritis (TA), who underwent extra-anatomical bypass surgery using biosynthetic grafts. METHODS This retrospective study included 12 TA patients considered eligible for surgical revascularization between January 2005 and May 2011 from two vascular surgical units in Turkey. Control group consisted of 12 peripheral arterial disease patients who underwent supra-aortic extra-anatomical bypass surgery using polytetrafluoroethylene (PTFE) graft. Preoperatively, all patients underwent Doppler ultrasound and arteriography. Patients were examined every 3 months for clinical findings after monthly follow-up during the first 6 months, first, second and third year controls. Graft patencies were evaluated by Doppler ultrasound at each visit. RESULTS The mean age was 38.6 ± 4.2 years and the mean follow-up time was 37.9 ± 6.9 months for the study group. In Biosynthetic Group, subclavian-subclavian (n = 2), axillo-axillary (n =9) and carotico-subclavian (n = 1) bypass operations were performed. In PTFE group, subclavian-subclavian (n = 3), axillo-axillary (n = 7), subclavian-left ulnar (n = 1), subclavian-distal brachial (n = 1) bypass operations were performed. Graft occlusion occurred in four patients in PTFE Group during follow-up period. These occlusive lesions were treated successfully according to the routine of each vascular unit. CONCLUSION We concluded that in inflammatory diseases like TA, biosynthetic grafts have promising patency, postoperative clinical findings and lower rates of complications requiring reintervention in mid-term.
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Affiliation(s)
- Berkan Ozpak
- Department of Cardiovascular Surgery, Tekirdag State Hospital, Tekirdag, Turkey
| | - Gokhan Ilhan
- Department of Cardiovascular Surgery, Faculty of Medicine, Recep Tayyip Erdogan University, Tekirdag, Turkey
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Haraguchi T, Urasawa K, Nakama T, Nakagawa Y, Tan M, Koshida R, Sato K. Sheath rendezvous method: a novel distal protection technique during endovascular treatment of subclavian artery occlusions. Cardiovasc Interv Ther 2015. [PMID: 26224140 DOI: 10.1007/s12928-015-0348-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To describe an innovative distal protection technique, "sheath rendezvous method", during endovascular treatment for subclavian arterial occlusions. 4.5F and 6F guiding sheath were inserted from left brachial and common femoral artery, respectively. 0.014″ guidewire retrogradely passed through occlusion and into antegrade sheath to establish a pull-through system. 3.0 mm balloon was used to expand occlusion and anchor to deliver retrograde sheath into antegrade one. Both sheaths locked by balloon dilatation crossed occlusion until antegrade sheath passed over lesion. Balloon expandable stent was delivered within antegrade sheath. Sheath was removed, and stent was implanted. We obtained an excellent outcome without complications.
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Affiliation(s)
- Takuya Haraguchi
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan.
| | - Kazushi Urasawa
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yuya Nakagawa
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan
| | - Michinao Tan
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan
| | - Ryoji Koshida
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan
| | - Katsuhiko Sato
- Cardiovascular Center, Tokeidai Memorial Hospital, 2-3, Higashi 1, Kita 1, Chuo-ku, Sapporo, Hokkaido, 060-0031, Japan
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Mousa AY, AbuRahma AF, Bozzay J, Broce M, Barsoum E, Bates M. Anatomic and clinical predictors of reintervention after subclavian artery stenting. J Vasc Surg 2015; 62:106-14. [DOI: 10.1016/j.jvs.2015.01.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
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Soga Y, Tomoi Y, Fujihara M, Okazaki S, Yamauchi Y, Shintani Y, Suzuki K. Perioperative and Long-term Outcomes of Endovascular Treatment for Subclavian Artery Disease From a Large Multicenter Registry. J Endovasc Ther 2015; 22:626-33. [DOI: 10.1177/1526602815590579] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To investigate the perioperative and long-term outcomes of endovascular therapy (EVT) for subclavian artery disease in a large-scale multicenter study. Methods: The study analyzed the outcomes from a multicenter retrospective registry (SubClavian Artery disease treated with endovascuLar therapy; muLticenter retrOsPective registry: SCALLOP) of 718 consecutive patients with upper extremity artery disease who underwent EVT between January 2003 and December 2012 at 37 Japanese cardiovascular centers. Of the 718 patients enrolled in the registry, 162 patients were excluded, leaving 553 patients (mean 70±7 years, range 41–91; 405 men) who underwent primary EVT for de novo subclavian artery disease (560 arms). Results: Procedure success was achieved in 96.8% (100% for stenoses, 91% for total occlusions). The perioperative complication rate was 9.2%. Stroke was found in 1.8%, with ipsilateral posterior infarction accounting for 0.9%. The 30-day mortality was 0.7%. The mean follow-up was 39±24 months. Primary patency estimates were 90.6%±1.3%, 83.4%±1.8%, and 80.5%±2.2% at 1, 3, and 5 years, respectively. There was no significant difference in primary patency between stenotic and occlusive lesions. Secondary patency estimates were 99.2%±0.4%, 98.2%±0.6%, and 97.7%±0.8% at 1, 3, and 5 years, respectively. The respective overall survival rates were 94.6%±1.0%, 86.8%±1.7%, and 79.0%±2.4%. There were 86 deaths during follow-up, of which half were due to cardiovascular causes. On multivariate analysis, critical hand ischemia (hazard ratio [HR] 4.6, 95% CI 2.06 to 10.2, p<0.001), cerebrovascular disease (HR 1.9, 95% CI 1.14 to 3.06, p=0.01), current smoking (HR 1.8, 95% 1.14 to 2.79, p=0.01), and lesion length (in 1-cm increments; HR 1.02, 95% CI 1.00 to 1.04, p=0.03) were negative independent predictors of primary patency, while IVUS use (HR 0.6, 95% CI 0.30 to 0.96, p=0.04) was a positive predictor of primary patency. Conclusion: Primary angioplasty/stenting for subclavian artery disease afforded acceptable outcomes in terms of perioperative complications and long-term patency.
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Affiliation(s)
- Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yusuke Tomoi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Shinya Okazaki
- Department of Cardiology, Juntendo University Hospital, Tokyo, Japan
| | | | | | - Kenji Suzuki
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
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Chen SP, Hu YP. Waveform patterns and peak reversed velocity in vertebral arteries predict severe subclavian artery stenosis and occlusion. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1328-1333. [PMID: 25638312 DOI: 10.1016/j.ultrasmedbio.2014.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/05/2014] [Accepted: 12/15/2014] [Indexed: 06/04/2023]
Abstract
This study investigated the value of analyzing spectral Doppler waveform patterns and measuring the peak reversed velocity (PRV) of the vertebral artery (VA) in predicting proximal severe subclavian artery (SA) stenosis and occlusion. Fifty-one patients with proximal SA stenosis were studied retrospectively. Based on the depth of the mid-systolic notch, the Doppler waveforms of the ipsilateral VA were divided into five subtypes (type I, n = 8; type II, n = 8; type III, n = 6; type IV, n = 13; and type V, n = 16). PRV was also measured. PRV receiver operating characteristic curves were constructed to obtain the best cutoff value for predicting severe SA stenosis or complete SA occlusion. The results indicated that both VA Doppler waveform and PRV were associated with the degree of SA stenosis (p < 0.05). PRV and the Doppler waveform in the VA had similar accuracy in predicting SA occlusion (84.3%, 43/51). PRV was more accurate than VA waveforms in predicting severe SA stenosis (98%, 50/51 vs. 94.1%, 48/51). However, no significant differences between the two methods in predicting severe SA stenosis were observed (p = 0.84). Thus, with severe obstruction of the SA, typical Doppler waveform patterns of the VA could be observed. PRV is a helpful criterion in predicting severe stenosis and occlusion of the SA.
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Affiliation(s)
- Shun-Ping Chen
- Department of Ultrasonography, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.
| | - Yuan-Ping Hu
- Department of Ultrasonography, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.
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Mufty H, Janssen A, Schepers S. Dealing with symptomatic stenosis of the subclavian artery: Open or endovascular approach? A case report. Int J Surg Case Rep 2014; 5:441-3. [PMID: 24973522 PMCID: PMC4147573 DOI: 10.1016/j.ijscr.2014.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/06/2014] [Accepted: 04/30/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Stenosis of the subclavian artery is uncommon and it rarely causes symptoms. Only symptomatic patients should be treated. PRESENTATION OF CASE We report a case of chronic left upper limb ischemia caused by subclavian artery stenosis after repetitive clavicular fixation. The stenosis was first treated with carotid-subclavian bypass and soon followed by angioplasty and stenting of the subclavian artery because of occlusion of the bypass. Finally, failure of these procedures necessitated a subclavian-axillary crossover bypass. DISCUSSION Both extra-anatomic bypass and percutaneous transluminal angioplasty are safe and effective. If feasible, many authors use endovascular treatment. According to literature, extra-anatomic bypass still remains the first choice of treatment for symptomatic patients. However, the introduction of routine stent implantation is equalling these results. Because of its lower long-term patency rate, endovascular treatment is favorable for patients at high risk. CONCLUSION Our case is a good example of difficulties involved in choosing the best treatment option for subclavian artery stenosis.
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Affiliation(s)
- Hozan Mufty
- Department of Vascular Surgery, AZ Damiaan, Ostend, Belgium.
| | | | - Stijn Schepers
- Department of Vascular Surgery, AZ Damiaan, Ostend, Belgium
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Stone PA, Srivastiva M, Campbell JE, Mousa AY. Diagnosis and treatment of subclavian artery occlusive disease. Expert Rev Cardiovasc Ther 2014; 8:1275-82. [DOI: 10.1586/erc.10.111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Endovascular Recanalization of the Chronically Occluded Brachiocephalic and Subclavian Arteries: Technical Considerations and an Argument for Embolic Protection. World Neurosurg 2013; 80:e327-36. [DOI: 10.1016/j.wneu.2012.04.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 04/24/2012] [Indexed: 11/19/2022]
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Subclavian revascularization in the age of thoracic endovascular aortic repair and comparison of outcomes in patients with occlusive disease. J Vasc Surg 2013; 58:901-9. [PMID: 23711694 DOI: 10.1016/j.jvs.2013.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/04/2013] [Accepted: 04/04/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Open surgical revascularization for subclavian artery occlusive disease (OD) has largely been supplanted by endovascular treatment despite the excellent long-term patency of bypass. The indications for carotid-subclavian bypass (C-SBP) and subclavian transposition (ST) have been recently expanded with the widespread application of thoracic endovascular aortic repair (TEVAR), primarily to augment proximal landing zones or treat endovascular failures. This study was performed to determine the outcomes of patients undergoing C-SBP/ST in the context of contemporary endovascular therapies and evolving indications. METHODS A prospective database including all procedures performed at a single institution from 2002 to 2012 was retrospectively queried for patients who underwent subclavian revascularization for TEVAR or OD indications. Patient demographics and perioperative outcomes were recorded. Patency was determined by computed tomography angiography in the TEVAR group. Noninvasive studies were used for the OD patients. Life-table methods were used to estimate patency, reintervention, and survival. RESULTS Of 139 procedures identified, 101 were performed for TEVAR and 38 for OD. All TEVAR patients underwent C-SBP/ST to augment landing zones (49% preoperative; 41% intraoperative), treat arm ischemia (8% postoperative), or for internal mammary artery salvage (2%). OD patients had a variety of indications, including failed stent/arm fatigue, 49%; asymptomatic >80% internal carotid stenosis with concurrent subclavian occlusion, 18%; symptomatic cerebrovascular OD, 13%; redo bypass, 8%; and coronary-subclavian steal, 5%. Differences in postoperative stroke and death, primary patency, or freedom from reintervention were not significant. The 30-day postoperative stroke, death, and combined stroke/death rates were, respectively, 10.8%, 5.8%, and 13.7% for the entire cohort; 8.9%, 7.1%, and 12.9% in TEVAR patients; and 15.8%, 2.6%, and 15.8% in OD patients. The 1- and 3-year primary patencies were, respectively, 94% and 94% for TEVAR and 93% and 73% for OD patients. Survival was similar between the groups, with an estimated survival rate of 88% at 1 year and 76% at 5 years. CONCLUSIONS Stroke risk in this contemporary series of C-SBP/ST performed for TEVAR and OD indications may be higher than previously reported in historical series. In TEVAR patients, this may be attributed to procedural complexity of the TEVAR in patients requiring subclavian revascularization. In OD patients, this is likely due to the changing patient population that requires more frequent concomitant carotid interventions. Despite the short-term morbidity, excellent bypass durability and equivalent long-term patient survival can be anticipated.
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Endovascular stenting for atherosclerotic subclavian artery stenosis in patients with other craniocervical artery stenosis. J Thromb Thrombolysis 2012; 35:107-14. [PMID: 22872507 DOI: 10.1007/s11239-012-0789-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Atherosclerotic subclavian artery stenosis (SAS) accompanied with other craniocervical artery stenosis (OCAS) is not uncommon in practice. We sought to investigate the safety and efficacy of endovascular stenting for SAS in patients with OCAS. Between January 2004 and February 2012, 71 consecutive atherosclerotic SAS patients who underwent primary stenting in our medical center were included. The enrolled patients were divided into combined-SAS group (n = 51) and solitary-SAS group (n = 20) depending on the presence or absence of OCAS. Data of demographics, procedure, and the followed-up were retrieved and analyzed. The technical success rate was 95.8%; the clinical success rate was 90.1%. There was no catheter-related major stroke or death. The immediate outcomes had no statistical difference between groups. During a mean of 27 ± 20 months (range 2-88 months) followed-up, 7 (10.3%) restenosis and 12 (17.6%) clinical events were identified. The primary patency rate was 95.3, 84.9 and 84.9% at 12, 24 months, and final followed-up respectively, which had no statistical difference between groups (odds ratio (OR), 2.60; 95% confidence interval (CI), 0.54-12.53; P = 0.232). The overall clinical event-free survival rate was 93.5, 86.2 and 54.6%, respectively, where the result of combined-SAS group was inferior to that of the solitary-SAS group (OR, 3.34; 95% CI, 1.02-11.00; P = 0.047). Endovascular stenting was safe and feasible for atherosclerotic SAS in patients with OCAS, although the combined OCAS may have a significant influence on the long-term outcome. Further studies are warrant to investigate the effects of revascularization for multiple craniocervical artery stenoses on the cerebral hemodynamics and long-term outcomes.
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Direct Percutaneous Access Technique for Transaxillary Transcatheter Aortic Valve Implantation. JACC Cardiovasc Interv 2012; 5:477-486. [DOI: 10.1016/j.jcin.2011.11.014] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/03/2011] [Accepted: 11/24/2011] [Indexed: 11/20/2022]
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Kim YW, Kim DI, Park YJ, Yang SS, Lee GY, Kim DK, Kim K, Sung K. Surgical bypass vs endovascular treatment for patients with supra-aortic arterial occlusive disease due to Takayasu arteritis. J Vasc Surg 2012; 55:693-700. [DOI: 10.1016/j.jvs.2011.09.051] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 09/07/2011] [Accepted: 09/07/2011] [Indexed: 10/15/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. Stroke 2011; 42:e420-63. [DOI: 10.1161/str.0b013e3182112d08] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Thomas G. Brott
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Jonathan L. Halperin
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Suhny Abbara
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - J. Michael Bacharach
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - John D. Barr
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Christopher U. Cates
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Mark A. Creager
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Susan B. Fowler
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Gary Friday
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - E. Bruce McIff
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Peter D. Panagos
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Thomas S. Riles
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Robert H. Rosenwasser
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Allen J. Taylor
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. Circulation 2011; 124:489-532. [DOI: 10.1161/cir.0b013e31820d8d78] [Citation(s) in RCA: 406] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas G. Brott
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Jonathan L. Halperin
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Suhny Abbara
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - J. Michael Bacharach
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - John D. Barr
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Christopher U. Cates
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Mark A. Creager
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Susan B. Fowler
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Gary Friday
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - E. Bruce McIff
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Peter D. Panagos
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Thomas S. Riles
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Robert H. Rosenwasser
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Allen J. Taylor
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/ SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. Vasc Med 2011; 16:35-77. [DOI: 10.1177/1358863x11399328] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. J Am Coll Cardiol 2011; 57:1002-44. [DOI: 10.1016/j.jacc.2010.11.005] [Citation(s) in RCA: 262] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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49
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. J Am Coll Cardiol 2011; 57:e16-94. [PMID: 21288679 DOI: 10.1016/j.jacc.2010.11.006] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Stroke 2011; 42:e464-540. [PMID: 21282493 DOI: 10.1161/str.0b013e3182112cc2] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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