Late stent fractures after endoluminal treatment of ostial supraaortic trunk arterial occlusive lesions.
OBJECTIVE
Percutaneous catheter-based treatment of supraaortic trunk arterial occlusive lesions obviates the need for extraanatomic bypass or median sternotomy. Although early results have been encouraging, late outcomes have yet to be defined. Reported are long-term outcomes of supraaortic trunk stent placement with particular attention to structural failures.


METHODS
This was a retrospective review of 27 ostial supraaortic trunk lesions managed with balloon-expandable or self-expandable stents. Treated vessels were innominate (n = 9), common carotid (n = 8), and subclavian (n = 10). Access to the target lesion was achieved either antegrade via the femoral artery (n = 13), retrograde through the brachial artery (n = 2), or through a cutdown on the common carotid artery (n = 12). Restenosis and stent integrity were detected with duplex imaging, computed tomography, conventional arteriography, and plain radiography. Mean follow-up time is 34 months.


RESULTS
Mean age was 68 years (eight men and 19 women), and mean stenosis was 85%. Preprocedural symptoms, including stroke, transient ischemic attack, arm fatigue, digital ischemia, and angina were present in 85% (23 of 27) of the group. At 30 days, there were no deaths, myocardial infarctions, or strokes. During follow-up, three type IV stent fractures in the innominate were detected as well as two midbody stent crush deformities with significant restenosis (one innominate and one common carotid). All stent failures were identified in heavily calcified lesions.


CONCLUSIONS
Endoluminal stent placement in supraaortic trunk lesions is a viable early solution; however, mid- to long-term restenosis caused by bare metal fatigue and fractures, particularly in cases of calcified innominate artery lesions, are a worrisome finding.
Usman
Asad A
AA
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 650, Chicago, IL 60611, USA.
Resnick
Scott A
SA
Benzuly
Keith H
KH
Beohar
Nirat
N
Eskandari
Mark K
MK
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D016122:Brachiocephalic Trunk; D002114:Calcinosis / Q000150:complications; D016893:Carotid Stenosis / Q000628:therapy; D016009:Chi-Square Distribution; D002641:Chicago; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013314:Stress, Mechanical; D013348:Subclavian Artery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
D008670:Metals