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Zhao TY, Xu GQ, Xue JY, Cai DY, Yang BW, Ba YY, Feng CY, Li TX, Gao BL, Chen ZC. Effects of percutaneous endovascular angioplasty for severe stenosis or occlusion of subclavian artery. Sci Rep 2024; 14:14290. [PMID: 38906992 DOI: 10.1038/s41598-024-65302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/19/2024] [Indexed: 06/23/2024] Open
Abstract
To investigate the effect and safety of percutaneous endovascular angioplasty (PEA) with optional stenting for the treatment of severe stenosis or occlusion of subclavian artery, patients with severe stenosis ≥ 70% or occlusion of subclavian artery treated with PEA were retrospectively enrolled. The clinical data were analyzed. A total of 222 patients were retrospectively enrolled, including 151 males (68.0%) and 71 females (32.0%) aged 48-86 (mean 63.9 ± 9.0) years. Forty-seven (21.2%) patients had comorbidities. Subclavian artery stenosis ≥ 70% was present in 201 (90.5%) patients and complete subclavian occlusion in 21 (9.5%) cases. Angioplasty was successfully performed in all (100%) patients. Balloon-expandable stents were used in 190 (85.6%) cases, and self-expandable stents in 20 (9.0%) cases. Only 12 (5.4%) cases were treated with balloon dilation only. Among 210 patients treated with stent angioplasty, 71 (33.8% or 71/210) cases underwent balloon pre-dilation, 139 (66.2% or 139/210) had direct deployment of balloon-expandable stents, and 2 (1.0% or 2/210) experienced balloon post-dilation. Distal embolization protection devices were used in 5 (2.3% or 5/222) cases. Periprocedural complications occurred in 3 (1.4%) patients, including aortic dissection in 2 (0.9%) cases and right middle cerebral artery embolism in 1 (0.5%). No hemorrhage occurred. Among 182 (82.0%) patients with 6-month follow-up, restenosis > 70% occurred in 1 (0.5%) patient, and among 68 (30.6%) patients with 12-month follow-up, restenosis > 70% took place in 11 (16.2%) patients. Percutaneous endovascular angioplasty can be safely and efficiently performed for the treatment of severe stenosis ≥ 70% or occlusion of subclavian artery.
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Affiliation(s)
- Tong-Yuan Zhao
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Gang-Qin Xu
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Jiang-Yu Xue
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China.
| | - Dong-Yang Cai
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Bo-Wen Yang
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Yue-Yang Ba
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Chen-Yi Feng
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Tian-Xiao Li
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China.
| | - Bu-Lang Gao
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Zhong-Can Chen
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
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Liang S, Zhang A, Li F, Xia Y, Feng G, Xu B, Wang H. Clinical study of 57 cases of endovascular treatment for total subclavian artery occlusion. Vascular 2024:17085381241254426. [PMID: 38753492 DOI: 10.1177/17085381241254426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To investigate the safety and efficacy of endovascular treatment for totally occlusive lesions of the subclavian artery (SCA). METHODS A retrospective study was performed on 57 patients treated with angioplasty and stenting, including 42 males and 15 females, with an average age of 61.8 years (range: 49 to 81 years). Efficacy, safety, and complications were evaluated. RESULTS Procedural success was achieved for 47/57 patients and symptoms were relieved. Rat-tail occlusion is the most common type, and all cases were successfully recanalized. Plain type occlusion is less common with a recanalization rate of 55.6%. Hilly and plain occlusions are the main types of stent implantation failure. Through univariate analysis and trend matching analysis, the type of SCA occlusion and surgical approach had statistical significance on the success rate of surgery. The mean follow-up time was 34.6 ± 16.2 months. The cumulative stent patency rates at 1, 3, and 5 years were 95.5%, 86.4%, and 77.3% in the calcified plaque group and 92.0%, 76.0%, and 68.0% in the non-calcified plaque group, respectively. The 3-year and 5-year patency rates in the calcified plaque group were higher than those in the non-calcified plaque group (p < .05). CONCLUSION Different occlusion types and surgical approaches can affect the surgical success rate. The combined femoral and brachial approach can improve the rate of recanalization of SCA occlusions. The patency rates at 3 and 5 years in the calcified plaque group were higher than those in the non-calcified plaque group.
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Affiliation(s)
- Shuangchao Liang
- Department of Vascular Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, P.R. China
| | - Andong Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, P.R. China
| | - Fangkuan Li
- Department of Vascular Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, P.R. China
| | - Youchuan Xia
- Department of Vascular Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, P.R. China
| | - Guilin Feng
- Department of Vascular Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, P.R. China
| | - Bei Xu
- Department of Vascular Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, P.R. China
| | - Haoran Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, P.R. China
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Nakata K, Nishigawa K, Yoshinaga T, Fukui T. Acute heart failure due to coronary subclavian steal syndrome after coronary artery bypass grafting. Clin Case Rep 2023; 11:e07326. [PMID: 37180329 PMCID: PMC10167612 DOI: 10.1002/ccr3.7326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/14/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
Key clinical message An axillo-axillary bypass grafting is useful for coronary subclavian steal syndrome when occlusion of the proximal left subclavian artery. Abstract An 81-year-old female who had undergone coronary artery bypass grafting 15 years previously was admitted and diagnosed with coronary subclavian steal syndrome. Preoperative angiography showed backflow from the left anterior descending coronary artery to the left internal thoracic artery and occlusion of the proximal left subclavian artery. Axillo-axillary bypass grafting was successfully performed.
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Affiliation(s)
- Kosuke Nakata
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
| | - Kosaku Nishigawa
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
| | - Takashi Yoshinaga
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
| | - Toshihiro Fukui
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
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Beloyartsev DF, Adyrkhaev ZA, Fagamov RR. [Treatment of atherosclerotic lesion of the first segment of subclavian artery]. Khirurgiia (Mosk) 2023:95-102. [PMID: 38088846 DOI: 10.17116/hirurgia202312195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Severe subclavian artery lesion is an important medical and social problem worsening the quality of life and leading to dire consequences. Vertebrobasilar insufficiency is the main syndrome of lesion of the first segment of subclavian artery. About 20% of all ischemic strokes occur in vertebrobasilar basin. At present, surgical treatment of asymptomatic patients with severe lesion of the 1st segment of subclavian artery is still debatable. Open surgery is optimal for occlusion of this vascular segment. Carotid-subclavian transposition is a preferable option with favorable in-hospital and long-term results. However, carotid-subclavian bypass is an equivalent alternative in case of difficult transposition following anatomical and topographic features of vascular architectonics. Endovascular treatment is preferable for isolated subclavian artery stenosis and should certainly include stenting.
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Affiliation(s)
- D F Beloyartsev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Z A Adyrkhaev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - R R Fagamov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Galyfos G, Liakopoulos D, Sigala F, Filis K. New paradigms in minimally-invasive vascular surgery. Expert Rev Cardiovasc Ther 2022; 20:207-214. [PMID: 35341434 DOI: 10.1080/14779072.2022.2058492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Vascular surgery has been greatly evolved during the last decades and novel minimally invasive techniques have been introduced. Aim of this review is to briefly present all these advances and compare them with traditional repairs. AREAS COVERED The authors have extensively searched literature through the Pubmed and Embase databases. All articles published up to December 2021 referring to minimally invasive techniques used for treatment of peripheral artery disease, carotid disease, aortic aneurysms and venous disease were evaluated. Minimally invasive techniques under investigation included endovascular and hybrid techniques, robot-assisted and laparoscopic approaches. EXPERT OPINION Several minimally invasive techniques such as endovascular and hybrid approaches have been extensively used during the last two decades to treat vascular surgery patients offering them lower mortality and morbidity risks. Novel robot assisted techniques have shown promising results in preclinical studies although further clinical evaluation is needed.
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Baghaffar A, Mashat M, EL-Andari R, Precious B, Aliter H, Herman C. Carotid to Left Subclavian Artery Bypass Grafting for the Treatment of Coronary Subclavian Steal Syndrome: A Case Report. CJC Open 2022; 4:647-650. [PMID: 35865019 PMCID: PMC9294988 DOI: 10.1016/j.cjco.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Abdullah Baghaffar
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Cardiac Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
- Corresponding author: Dr Abdullah Baghaffar, Division of Cardiac Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary, 2nd Floor, 2269-1796 Summer Street, Halifax, Nova Scotia B3H3A7, Canada. Tel: +1-902-223-6601; fax: +1-902-473-3808.
| | - Muhammed Mashat
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Cardiac Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ryaan EL-Andari
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Precious
- Department of Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hashem Aliter
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Herman
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Unmasking the Coronary-Subclavian Steal Syndrome: The Culprit Lies in the Subclavian Artery. A Report of a Case and Review of the Literature. Ann Vasc Surg 2021; 74:524.e9-524.e15. [PMID: 33836226 DOI: 10.1016/j.avsg.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 11/20/2022]
Abstract
The coronary-subclavian steal syndrome is a hemodynamic phenomenon in which a subclavian artery stenosis or occlusion impairs blood flow at the origin of the left internal mammary artery used for coronary artery bypass grafting (CABG), causing retrograde blood flow and thus provoking symptoms of cardiac ischemia and its complications. Once considered the gold-standard operation of choice, open revascularization has now been abandoned as a first line treatment and replaced by endovascular techniques. In all cases, detailed and oriented physical examination in combination with further imaging in high clinical suspicion for coronary-subclavian steal syndrome remains the sine qua non of the preoperative examination of the patient. We report the case of a 50-year-old male patient suffering from acute onset angina post- coronary artery bypass grafting and managed by endovascular means.
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Chen DW, Gao YH, Shi J, Yin YW, Zhang WQ. Significance of hemodynamic assessment by pressure wire for endovascular therapy of subclavian steal syndrome. Interv Neuroradiol 2020; 26:321-328. [PMID: 31969074 DOI: 10.1177/1591019919897765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Subclavian steal syndrome results from hemodynamic impairment due to stenosis or occlusion of subclavian artery. Therefore, it is important for subclavian steal syndrome patients to assess hemodynamic status during endovascular therapy. METHODS Eleven subclavian steal syndrome patients undergoing endovascular therapy attended this study. Pressure wire was used to measure trans-stenosis pressure difference (ΔP). Digital subtraction angiography, Transcranial Doppler and Electronic sphygmomanometer were introduced to assess stenotic rate, steal grade and inter-arm systolic pressure difference, respectively. Clinical symptoms and restenosis were followed up after endovascular therapy. The associations of ΔP with stenotic rate, inter-arm pressure difference, steal degree, clinic symptoms and restenosis were analyzed in this paper. RESULTS Prior to the therapy, ΔP moderately correlated with stenotic rate (r = 0.757, p = 0.007) and inter-arm pressure difference (r = 0.701, p = 0.016). ΔP was ≥6 mmHg in all patients, and 6-9 mmHg for grade 1 steal and ≥10 mmHg for grade 2 and 3 steals. After the therapy, all patients had technique success, and 10 patients had clinic success, and 1 patient appeared restenosis. ΔP was ≤3 mmHg and steal disappeared in the patients with clinical success. ΔP was 18 mmHg and grade 3 steal still existed in one patient without clinical success. One patient with 1 mmHg of ΔP after therapy appeared restenosis in the follow-up. CONCLUSION The trans-stenosis pressure difference is closely related to steal degree and clinical symptoms. The measurement of hemodynamic status by pressure wire is very useful to guide endovascular therapy in subclavian steal syndrome patients. However, the restenosis may still occur, even though the hemodynamic impairment is improved.
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Affiliation(s)
- Da-Wei Chen
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
| | - Yu-Hai Gao
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Jin Shi
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
| | - Yan-Wei Yin
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
| | - Wei-Qing Zhang
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
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Benhammamia M, Mazzaccaro D, Ben Mrad M, Denguir R, Nano G. Endovascular and Surgical Management of Subclavian Artery Occlusive Disease: Early and Long-Term Outcomes. Ann Vasc Surg 2019; 66:462-469. [PMID: 31863950 DOI: 10.1016/j.avsg.2019.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The aim of the study was to report early and late outcomes of surgical and endovascular management of subclavian artery atherosclerotic disease (SAAD). METHODS Data about consecutive patients treated for subclavian artery atherosclerotic occlusive disease between 2001 and 2018 either by open surgical repair (OSR) or by endovascular repair (ER) were retrospectively collected and analyzed. Primary outcomes included 30-day death, as well as cardiac and neurologic events, reported separately for occlusion and stenosis. Secondary outcomes included primary patency in the long term, reported separately for occlusive and stenotic lesions. The Kaplan-Meier analysis with the logrank test was used to estimate long-term primary patency. Chi-squared and t-tests were used as appropriate to compare the outcomes of the 2 groups. A P value < 0.05 was considered statistically significant. RESULTS Sixty-eight patients were treated using ER (49 patients) and OSR (19). Technical success rate was 100% in both groups. During in-hospital stay, 1 brachial hematoma and 2 acute upper limb ischemia occurred in the ER group and in the OSR group, respectively. At 30 days, no deaths or neurological/cardiac events were recorded in both ER and OSR groups. Symptoms resolution and upper limb salvage were 100% in both groups. In the ER group, primary patency was 100% at 7 years in patients who had been treated for stenotic lesions and 62.5 ± 21.3% in patients who had been treated for occlusive lesions (P = 0.0035). In the OSR group, primary patency was 100% at 7 years in patients treated for stenotic lesions and 25 ± 21.6% in patients who had been treated for occlusive lesions (P < 0.0001). Overall, long-term primary patency in the OSR group was 76.9 ± 11.7% at 7 years, being lower than that reported after ER (93.4 ± 4.5%, P = 0.02). CONCLUSIONS Both ER and OSR proved to be safe, effective, and durable in the treatment of SAAD. In particular, the primary patency rates at long term for both ER and OSR showed better outcomes for stenotic lesions.
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Affiliation(s)
- Mohamed Benhammamia
- Cardiovascular Surgery Department of La Rabta University Hospital, Tunis, Tunisia
| | - Daniela Mazzaccaro
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - Malek Ben Mrad
- Cardiovascular Surgery Department of La Rabta University Hospital, Tunis, Tunisia
| | - Raouf Denguir
- Cardiovascular Surgery Department of La Rabta University Hospital, Tunis, Tunisia
| | - Giovanni Nano
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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