Results after balloon angioplasty or stenting of atherosclerotic subclavian artery obstruction.
BACKGROUND
Endovascular therapy is an accepted treatment strategy in occlusive disease of the subclavian artery. The purpose of this study was to evaluate the technical and clinical long-term outcome following either balloon angioplasty (plain balloon angioplasty (PTA)) or stenting.


METHODS
The authors retrospectively analyzed 108 interventions of atherosclerotic lesions of subclavian arteries or the brachiocephalic trunk (107 patients; mean age of 66 +/- 9 years; 90% symptomatic) representing 92% of the patients treated with subclavian artery obstructive disease during a 10-year period. Primary endpoint of the study was the 1-year primary patency rate. Follow-up was based on oscillometry, Doppler blood pressure measurements, and duplex ultrasound.


RESULTS
The primary success rate was 97% (100% for stenoses (78/78) and 87% for total occlusions (26/30)). Treatment modalities included PTA alone (13%; n = 14) or stenting (87%; n = 90) with balloon-expandable (n = 61), self-expanding (n = 17), or both types of devices (n = 12). The 1-year primary patency rate of the 97 patients eligible for follow-up was 88%, for the subgroups 79% (PTA) and 89% (stenting; P = 0.2). The blood pressure difference between both limbs at baseline was 45 +/- 26 mm Hg and dropped to 10 +/- 14 mm Hg (P < 0.001) after the intervention and 15 +/- 19 mm Hg at 1 year (P < 0.01).


CONCLUSIONS
Endovascular therapy of atherosclerotic subclavian artery obstructions result in excellent acute success rates even in total occlusions. Results evince good durability of endovascular therapy for atherosclerotic occlusive disease of subclavian arteries and with a trend towards better outcome with stenting compared to PTA.
Sixt
Sebastian
S
Department of Angiology, Heart Centre, Bad Krozingen, Germany.
Rastan
Aljoscha
A
Schwarzwälder
Uwe
U
Bürgelin
Karlheinz
K
Noory
Elias
E
Schwarz
Thomas
T
Beschorner
Ulrich
U
Frank
Ulrich
U
Müller
Christian
C
Hauk
Michael
M
Leppanen
Olli
O
Hauswald
Kirsten
K
Brantner
Regina
R
Nazary
Taher
T
Neumann
Franz-Josef
FJ
Zeller
Thomas
T
D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000601:surgery*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D011859:Radiography; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D013349:Subclavian Steal Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome