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Percutaneous transluminal angioplasty for atherosclerotic stenosis of the subclavian or innominate artery: angiographic and clinical outcomes in 36 patients

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Abstract

The purpose of the study was to evaluate stenting and percutaneous transluminal angioplasty (PTA) for the treatment of stenotic lesions of the subclavian or innominate artery based on surgical results and long-term follow-up with 36 patients. In particular, we evaluated the efficacy of self-expanding stents compared to balloon-expandable stents. Between February 2000 and March 2008 at the Kyoto Medical Center, 36 patients underwent both stenting and PTA of the subclavian or innominate artery. Twenty-four patients had severe subclavian stenotic disease, ten patients had total occlusion of the subclavian artery, and two patients had stenoses of the innominate artery. Successful dilatation (less than 30% residual stenosis) was obtained in 34 of the 36 cases. In two cases (20%) of total subclavian occlusion, the guidewires were not able to penetrate the lesions, although the success rate was 100% for stenoses. All patients had no signs of neurological side effects with the exception of two pseudoaneurysms of the femoral arteries that required surgical intervention. In the first 30 days after treatment, there were no strokes or deaths. Outpatient follow-up was done with 30 patients (83.3%) after a mean of 30.9 months (range 3–114). Among these 30 patients, four patients (13.3%) developed restenoses of over 50%. Restenoses occurred in 4 of 20 individuals (20%) who received balloon-expandable stents but were not observed in those who received self-expanding stents. Endovascular therapy for the subclavian and innominate arteries is less invasive and safer than open surgery, making it the preferable option. In this clinical period, the rate of restenosis using self-expanding stents was lower than the rate using balloon-expandable stents.

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Disclosure

The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan

    Akinori Miyakoshi & Susumu Yamaguchi

  2. Department of Neurosurgery, Kyoto University, Graduate School of Medicine Center, Kyoto, Japan

    Taketo Hatano

  3. Department of Neurosurgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan

    Tetsuya Tsukahara, Mamoru Murakami, Daisuke Arai & Susumu Yamaguchi

Authors
  1. Akinori Miyakoshi
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  2. Taketo Hatano
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  3. Tetsuya Tsukahara
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  4. Mamoru Murakami
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  5. Daisuke Arai
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  6. Susumu Yamaguchi
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Corresponding author

Correspondence to Akinori Miyakoshi.

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Comments

Gerasimos Baltsavias, Zurich, Switzerland

This is a nice series of patients who underwent endovascular treatment for stenotic lesions of the subclavian or innominate artery. The authors present their technique related to vertebral artery protection and a combined femoral or brachial approach for cases of severe stenosis or occlusion of the subclavian. Not surprisingly, their results showed that self-expanding stents compared to balloon-expandable stents performed better in terms of restenosis rate even in the long-term follow-up.

Giuseppe Lanzino, Rochester, USA

The authors report their experience with a relatively large series of 36 patients who underwent stent-assisted angioplasty for stenosis or occlusion of the subclavian artery and the brachiocephalic trunk. Unlike many of the experiences so far reported with these vessels, these authors advocate a combined transbrachial and transfemoral approach which allows for the placement of a protective balloon in the vertebral and/or the carotid artery potentially decreasing the incidence of periprocedural emboli. The authors have noted an increased incidence of restenosis with balloon-expandable stents compared to self-expanding stents and this is in line with the experience in other vascular territories such as the internal carotid artery. This report confirms the primary role of endovascular therapy for the treatment of symptomatic stenosis of the subclavian artery and the brachiocephalic trunk. In addition, this study exemplifies how continuous refinements in endovascular techniques result in improved and safer strategies.

Oliver Bozinov, Zurich, Switzerland

This is a very nice paper about percutaneous transluminal angioplasty for atherosclerotic stenosis of the subclavian or innominate artery that shows, that self expandable stents are better to use in these cases. The paper is focused and covers a reasonable follow-up time. For statistical analysis this case series is too small but I guess it is simply impossible to gather a large enough series to do so. Especially considering the fast technological evolution in this field. The results are comparable to the international literature and therefore very good.

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Miyakoshi, A., Hatano, T., Tsukahara, T. et al. Percutaneous transluminal angioplasty for atherosclerotic stenosis of the subclavian or innominate artery: angiographic and clinical outcomes in 36 patients. Neurosurg Rev 35, 121–126 (2012). https://doi.org/10.1007/s10143-011-0328-3

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  • DOI: https://doi.org/10.1007/s10143-011-0328-3

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