title: Risk stratification for subclavian artery angioplasty: is there an increased rate of restenosis after stent implantation?
abstract: OBJECTIVE
  To compare long-term patency after balloon angioplasty of stenotic or occluded subclavian arteries with and without adjunctive stenting and to identify independent risk factors for restenosis after balloon angioplasty.
  
  
  METHODS
  In a retrospective cohort study, 115 consecutive patients (65 women; mean age 60 years, interquartile range 53-68) who underwent PTA for atherosclerotic subclavian artery obstruction within a 15-year period were included. Among these, 26 (23%) consecutive patients had Palmaz stents routinely implanted since 1996. Follow-up investigation was performed in the year 2000. Patency during the median 44-month follow-up period (interquartile range 18-69 months, minimum 12) was evaluated by oscillography, blood pressure measurement, and color-coded duplex sonography. The predictive value of possible risk factors for restenosis was assessed in a multivariate model controlling for cardiovascular comorbidities and angiographic data.
  
  
  RESULTS
  PTA success was achieved in 98 (85%) patients, 72 (81%) of 89 undergoing angioplasty alone and all 26 with stents. Complete occlusion of the vessel and long lesions (> or = 2 cm) correlated with a lower success rate. One-year patency was 76% in unstented arteries and 95% in stented lesions due to better primary technical success, but at 4 years, the patency rates were 59% in arteries with stents and 68% in arteries without. Long lesions, residual stenosis after PTA, and stent implantation were independent predictors for restenosis after successful intervention.
  
  
  CONCLUSIONS
  Subclavian arterial stent implantation is associated with better 1-year patency than PTA due to improved technical success, but intermediate and long-term outcomes are less favorable, as instent restenosis frequently occurs.
authors.affiliation: Department of Internal Medicine II, University of Vienna Medical School, Austria. martin.schillinger@akh-wien.ac.at
authors.forename: M
authors.initials: M
authors.lastname: Schillinger
authors.forename: M
authors.initials: M
authors.lastname: Haumer
authors.forename: S
authors.initials: S
authors.lastname: Schillinger
authors.forename: R
authors.initials: R
authors.lastname: Ahmadi
authors.forename: E
authors.initials: E
authors.lastname: Minar
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods; D014654:Vascular Patency