Catheter-based treatment of the subclavian and innominate arteries.
OBJECTIVE
We report outcomes in patients undergoing catheter-based intervention for symptomatic subclavian and innominate artery (S/IA) atherosclerosis.


BACKGROUND
Symptomatic S/IA obstructive lesions have traditionally been treated with open surgical revascularization. Catheter-based endovascular therapies reduce the morbidity and mortality associated with surgery in many vascular beds.


METHODS
Between December 1993 and May 2006, 170 patients underwent primary stent placement in 177 S/IA arteries. Indications for revascularization included arm ischemia (57%), subclavian steal syndrome (37%), coronary-subclavian steal syndrome (21%), and planned coronary bypass surgery with the involved internal mammary artery (8%).


RESULTS
Technical success was achieved in 98.3% (174/177) arteries, including 99.4% for stenotic lesions (155/156) and 90.5% for occlusions (19/21). There were no procedure-related deaths and one stroke (0.6%, 1/170). Follow-up was obtained in 151 (89%) patients at 35.2 +/- 30.8 months, with a target vessel revascularization rate of 14.6% (23/157). At last follow-up, 82% (124/151) of all treated patients remained asymptomatic with a primary patency of 83% and a secondary patency of 96%.


CONCLUSIONS
Catheter-based revascularization with stents for symptomatic S/IA lesions is safe and effective with excellent patency rates and sustained symptom resolution in the majority (>80%) of patients over 3 years of follow-up. Percutaneous primary stent therapy is the preferred method of revascularization in patients with suitable anatomy.
Patel
Samir N
SN
Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana 70123, USA. spatel@ochsner.org
White
Christopher J
CJ
Collins
Tyrone J
TJ
Daniel
Gary A
GA
Jenkins
J Stephen
JS
Reilly
J P
JP
Morris
Rachael F
RF
Ramee
Stephen R
SR
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001132:Arm / Q000098:blood supply*; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D013349:Subclavian Steal Syndrome / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy