Endovascular therapy of subclavian artery occlusive disease involving 					the vertebral artery origin

Summary. Background: While the majority of subclavian artery (SA) lesions are localized in the proximal segment, the evidence in patients with medial SA disease involving the vertebral artery (VA) origin are scarce. Patients and methods: We retrospectively analyzed all patients who underwent percutaneous revascularization of the SA at our institution. Results: A total of 196 patients were retrospectively analyzed. The majority of SA lesions (n = 163, 83 %) were located in the proximal segment, whereas 28 lesions (14 %) were located in the medial segment, and only 5 lesions (3 %) involved the distal segment. Procedural success was high for both stenosis (96 %) and occlusion (89 %) and did not differ depending on lesion location. Revascularization techniques in the medial segment included stenting of the SA only (13 patients), additional VA balloon-dilatation (6 patients), and bifurcation stenting of the SA and VA using T-stenting technique (9 patients). Outcome after a median of 12 months showed no significant differences in freedom from restenosis between proximal and medial lesions (90 % vs. 95 %; p = 0.67). Conclusions: Endovascular revascularization of SA disease with medial segments involving the VA origin required more complex techniques and showed long-term patency rates comparable to those in lesions located within the proximal SA.

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P4707Incidence and outcome of endovascular therapy in subclavian occlusive disease involving the vertebral artery origin

European Heart Journal ◽

10.1093/eurheartj/ehz745.1088 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V S Schneider ◽

R Dirschinger ◽

I Wustrow ◽

S Cassese ◽

M Fusaro ◽

...

Keyword(s):

Vertebral Artery ◽

Subclavian Artery ◽

Endovascular Therapy ◽

Innominate Artery ◽

Distal Segment ◽

Proximal Segment ◽

Special Focus ◽

Medial Segment ◽

Artery Disease

Abstract Background Endovascular revascularization represents the treatment option of choice in symptomatic steno-occlusive disease of the subclavian artery (SA). While the majority of lesions are localized in the proximal segment of the subclavian artery, studies in regards to the medial segment involving the vertebral artery (VA) origin are scarce. Purpose The aim of this study was to analyze the technical approaches and outcome of endovascular therapy of subclavian artery disease with a special focus on medial lesions involving the VA origin. Methods We retrospectively analyzed all patients who underwent percutaneous revascularization of the subclavian or innominate artery with a special focus on medial lesions involving the VA origin. Results In total 196 patients with subclavian or innominate artery intervention were analyzed. The majority of lesions (83%) were located in the proximal, whereas 28 patients (14%) presented with lesions in the medial segment of the SA, and only 3% involved the distal segment. Overall procedural success was high for both stenosis (96%) and occlusion (89%) and did not differ according to the lesion location. Revascularization techniques in the medial segment included stenting of the SA only (13 patients), additional VA balloon-dilatation (6 Patients), and bifurcational stenting of the SA and VA using T-stenting technique (9 patients). Overall periprocedural complication rate was low (6%) and comparable between different SA segments (6% in proximal segment vs. 7% in medial segment vs. 0% in distal segment; p=0.81). Outcome assessed after a median of 12 months (interquartile range 4–30) showed no significant differences in terms of Kaplan-Meier estimated freedom from restenosis between proximal and medial lesions despite the technically demanding approach in the medial segment (90% vs. 95%; p=0.67). Long-term patency Conclusion Endovascular revascularization of medial subclavian artery lesions involving the vertebral artery origin shows comparable safety and efficacy in terms of long-term patency rates compared to lesions located within the proximal subclavian artery. However, more complex endovascular techniques with bifurcational ballooning or stenting is required in a considerable number of patients with medial subclavian artery disease.

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PP-134 The Successful Percutaneous Revascularization of Subclavian Artery Stenosis Causing Coronary Subclavian and Vertebral Artery Steal Syndrome

The American Journal of Cardiology ◽

10.1016/j.amjcard.2015.01.491 ◽

2015 ◽

Vol 115 ◽

pp. S156-S157

Author(s):

Sadik Acikel ◽

Lale Dinc Asarcikli ◽

Ahmet Akyel ◽

Tolga Cimen ◽

Tolgahan Efe ◽

...

Keyword(s):

Vertebral Artery ◽

Subclavian Artery ◽

Artery Stenosis ◽

Subclavian Artery Stenosis ◽

Percutaneous Revascularization ◽

Steal Syndrome

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Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease

Vascular and Endovascular Surgery ◽

10.1177/1538574418824444 ◽

2019 ◽

Vol 53 (4) ◽

pp. 284-291

Author(s):

Hirokazu Onishi ◽

Toru Naganuma ◽

Koji Hozawa ◽

Tomohiko Sato ◽

Hisaaki Ishiguro ◽

...

Keyword(s):

Subclavian Artery ◽

Stent Implantation ◽

De Novo ◽

Clinical Success ◽

Primary Patency ◽

Success Rates ◽

Long Term Outcomes ◽

Procedural Success

Introduction: The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. Material and Methods: We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. Results: There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). Conclusion: Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.

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Persistent second cervical intersegmental artery in a case of possible PHACE syndrome

Interventional Neuroradiology ◽

10.1177/1591019920945553 ◽

2020 ◽

pp. 159101992094555

Author(s):

Philippe Gailloud

Keyword(s):

Vertebral Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Internal Carotid ◽

Proximal Segment ◽

Phace Syndrome ◽

Arterial Variations

The proximal segment of the vertebral artery most often consists of a persistent sixth cervical intersegmental artery that originates from the subclavian artery, but it may also derive from a fifth, fourth, or third cervical intersegmental artery (in decreasing order of frequency), or from a first thoracic intersegmental artery. The involvement of more cranial cervical branches is exceptional, with no known persistent first cervical intersegmental artery and possibly five cases of persistent second cervical intersegmental arteries reported so far. This report describes a patient with multiple arterial variations including right persistent second cervical intersegmental artery of common carotid origin, distal VA duplication, circumflex aortic arch, and segmental internal carotid agenesis in a context of possible PHACE syndrome.

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Influence of Procedural Success on Immediate and Long-Term Clinical Outcome of Patients Undergoing Percutaneous Revascularization of Occluded Coronary Artery Bypass Vein Grafts

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(96)00414-7 ◽

1996 ◽

Vol 28 (7) ◽

pp. 1732-1737 ◽

Cited By ~ 21

Author(s):

Peter B. Berger ◽

Malcolm R. Bell ◽

Diane E. Grill ◽

Robert Simari ◽

Guy Reeder ◽

...

Keyword(s):

Coronary Artery ◽

Clinical Outcome ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Vein Grafts ◽

Procedural Success ◽

Percutaneous Revascularization

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Exposure of the V1–V3 segments of the vertebral artery via the posterior cervical triangle: a cadaveric feasibility study

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.5.4.320 ◽

2006 ◽

Vol 5 (4) ◽

pp. 320-323 ◽

Cited By ~ 5

Author(s):

R. Shane Tubbs ◽

Mohammadali M. Shoja ◽

Leslie Acakpo-Satchivi ◽

John C. Wellons ◽

Jeffrey P. Blount ◽

...

Keyword(s):

Vertebral Artery ◽

Feasibility Study ◽

Subclavian Artery ◽

Sternocleidomastoid Muscle ◽

Proximal Segment ◽

Surgical Exposure ◽

Left And Right ◽

Equal Efficacy

Object Surgical exposure of the extracranial part of the vertebral artery (VA) is occasionally necessary. Historically, the greater portion of the extracranial portion of the VA has been approached by traversing the anterior cervical triangle. The authors speculated that this entire segment of the VA could be reached with equal efficacy via the posterior cervical triangle (PCT). Methods Six adult cadavers underwent dissection of the left and right VAs via the PCT. The entire extracranial VA was easily exposed through this approach. Only three of 12 sides required the transection of the clavicular head of the sternocleidomastoid muscle for exposure of the most proximal segment of the VA as it originated from the subclavian artery. No gross injury to the VA or other regional vessels or nerves was noted. Conclusions The authors found that the extracranial VA can be exposed easily through the PCT. Following confirmation of this technique in vivo, this approach may be added to the surgeon’s armamentarium for exposing the extracranial segment of the VA.

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Clinical and angiographic long-term outcomes of vertebral artery–subclavian artery transposition to treat symptomatic stenosis of vertebral artery origin

Journal of Neurosurgery ◽

10.3171/2008.10.jns08687 ◽

2009 ◽

Vol 110 (5) ◽

pp. 943-947 ◽

Cited By ~ 8

Author(s):

Shunsuke Kakino ◽

Kuniaki Ogasawara ◽

Yoshitaka Kubo ◽

Hiroshi Kashimura ◽

Hiromu Konno ◽

...

Keyword(s):

Vertebral Artery ◽

Subclavian Artery ◽

Neurological Deficits ◽

Long Term Outcomes ◽

Luminal Narrowing ◽

Long Term Follow Up ◽

Symptomatic Stenosis ◽

Ischemic Events

Object Although angioplasty and stent placement for vertebral artery (VA)–origin stenosis have been performed using endovascular techniques, a high likelihood of restenosis has been observed in the long term. Therefore, the authors assessed the long-term clinical and angiographic outcomes in patients after VA–subclavian artery (SA) transposition. Methods Thirty-six patients (31 men, 5 women; mean age 64.3 years, range 46–76 years) underwent clinical evaluation (modified Rankin Scale [mRS]) and cervical angiographic evaluation preoperatively and within 1 month of and 6 months after VA-SA transposition undertaken to treat symptomatic stenosis of VA origin. Results Postoperative neurological deficits due to intraoperative brain ischemia did not occur, and MR imaging demonstrated no new postoperative ischemic lesions in any of the patients. One patient died of acute myocardial infarction 2 months after surgery and another developed a left thalamic hemorrhage (mRS score of 5) at 42 months postsurgery. None of the remaining 34 patients experienced further ischemic events, and the mRS score in all of these patients remained unchanged during a mean follow-up period of 54 months. The degree of VA-origin stenosis (preoperative mean 84%) was reduced to ≤ 30% after surgery (mean 2%). Long-term follow-up angiography in 29 patients (81%) revealed the absence of restenosis, defined as > 50% luminal narrowing, in all of them. Conclusions The clinical and angiographic long-term outcomes demonstrated here suggest that VA-SA transposition will be useful in patients with symptomatic stenosis of VA origin.

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