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

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.

Download Full-text

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

VASA ◽

10.1024/0301-1526/a000842 ◽

2020 ◽

Vol 49 (3) ◽

pp. 205-213

Author(s):

Vera Schneider ◽

Ralf Dirschinger ◽

Isabel Wustrow ◽

Arne Müller ◽

Salvatore Cassese ◽

...

Keyword(s):

Vertebral Artery ◽

Subclavian Artery ◽

Distal Segment ◽

Proximal Segment ◽

Lesion Location ◽

Medial Segment ◽

Bifurcation Stenting ◽

Procedural Success ◽

Percutaneous Revascularization

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.

Download Full-text

A Simplified Pull-Through Angioplasty Technique without a Snare Device

Interventional Neuroradiology ◽

10.1177/159101991301900204 ◽

2013 ◽

Vol 19 (2) ◽

pp. 167-172 ◽

Cited By ~ 3

Author(s):

Y. Matsumoto ◽

K. Nakai ◽

M. Tsutsumi ◽

M. Iko ◽

H. Oishi ◽

...

Keyword(s):

Vertebral Artery ◽

Subclavian Artery ◽

Femoral Artery ◽

Brachial Artery ◽

Guide Wire ◽

The Body ◽

Wire Tension ◽

Artery Disease ◽

Pull Through ◽

Sheath Insertion

The pull-through angioplasty technique allows stable wire tension and stabilization of the device during the procedure. In this technique, a guide wire is passed from one sheath to another, usually with the aid of a snare device. We describe the treatment of occlusive subclavian artery disease and lesion at the origin of the vertebral artery employing a brachiofemoral pull-through technique without using a snare device. In this technique, the guide wire is advanced from the femoral artery to the brachial artery. The guide wire is directly inserted into the sheath placed at the brachial artery. The brachial artery is compressed proximal to the point of sheath insertion to prevent bleeding. The sheath is extracted temporally and the guide wire is caught outside of the body. The sheath is then introduced again through the guide wire. We used the pull-through technique without a snare device in seven cases, and we were able to build the pull-through system in six of these cases without a snare device. This pull-through technique without a snare device is not difficult to use, and may reduce the time and cost of angioplasty procedures.

Download Full-text

Endovascular Therapy for Steno-Occlusive Subclavian and Innominate Artery Disease

Circulation Journal ◽

10.1253/circj.cj-14-0855 ◽

2015 ◽

Vol 79 (3) ◽

pp. 537-543 ◽

Cited By ~ 10

Author(s):

Christian Bradaric ◽

Kristin Kuhs ◽

Philip Groha ◽

Michael Dommasch ◽

Nicolas Langwieser ◽

...

Keyword(s):

Endovascular Therapy ◽

Innominate Artery ◽

Artery Disease

Download Full-text

The Long-term Outcome after Axillo-axillary Bypass Grafting for Proximal Subclavian Artery Disease

European Journal of Vascular and Endovascular Surgery ◽

10.1053/ejvs.1999.0947 ◽

2000 ◽

Vol 19 (1) ◽

pp. 52-55 ◽

Cited By ~ 8

Author(s):

J.M.T. Perkins ◽

T.R. Magee ◽

L.J. Hands ◽

J. Collin ◽

P.J. Morris

Keyword(s):

Subclavian Artery ◽

Bypass Grafting ◽

Term Outcome ◽

Long Term Outcome ◽

Artery Disease

Download Full-text

Clinical Impact of Intravascular Ultrasound Guidance During Endovascular Treatment of Subclavian Artery Disease

Journal of Endovascular Therapy ◽

10.1177/1526602817722996 ◽

2017 ◽

Vol 24 (5) ◽

pp. 731-738 ◽

Cited By ~ 1

Author(s):

Wen-Jung Chung ◽

Yoshimitsu Soga ◽

Yusuke Tomoi ◽

Masahiko Fujihara ◽

Shinya Okazaki ◽

...

Keyword(s):

Multivariate Analysis ◽

Endovascular Treatment ◽

Intravascular Ultrasound ◽

Subclavian Artery ◽

Primary Patency ◽

Secondary Patency ◽

Complication Rates ◽

All Cause Mortality ◽

Artery Disease

Purpose: To evaluate the short- and long-term efficacy of intravascular ultrasound (IVUS) guidance during endovascular treatment (EVT) of subclavian artery disease. Methods: The multicenter SCALLOP registry (SubClavian Artery disease treated with endovascuLar therapy; muLticenter retrOsPective registry) was interrogated to identify 542 patients who underwent successful EVT for SCAD between January 2003 and December 2012. Lesions were classified according to the use of IVUS guidance: 177 patients (mean age 68.9±8.6 years; 149 men) with and 373 patients (mean age 69.9±8.7 years; 275 men) without. The main outcome was the difference in primary patency; secondary outcomes were differences in assisted primary patency, secondary patency, overall survival, freedom from major adverse cardiovascular events [MACE; all-cause mortality, myocardial infarction (MI), and stroke], and freedom from major adverse events (MAE). Multivariate analysis of the IVUS+ group was performed to identify predictors of failure; results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: In total, 538 (97.8%) lesions were treated with stents and 12 lesions by balloon angioplasty alone. Periprocedural and in-hospital overall complication rates did not differ significantly between IVUS+ (10.2%) and IVUS– (8.8%, p=0.617). Long-term follow-up demonstrated no significant difference between IVUS+ and IVUS– groups in 5-year all-cause mortality (p=0.37), MI (p=0.07), stroke (p=0.31), or MACE (p=0.07). However, 5-year primary patency was significantly higher in the IVUS+ group (88.5% vs 77.7%, p=0.03). There were no group differences in 5-year assisted primary patency (90.4% vs 89.9%, p=0.81) or secondary patency (99.4% vs 97.1%, p=0.25). Multivariate analysis of the IVUS+ group identified in-hospital stroke (HR 16.92, 95% CI 3.60 to 79.42, p<0.01) and combined use of balloon-expandable and self-expanding stents (HR 5.59, 95% CI 1.22 to 25.65, p=0.02) as independent negative predictors of primary patency. Conclusion: These results suggest that IVUS guidance can significantly improve long-term primary patency following endovascular treatment of subclavian artery disease.

Download Full-text

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.

Download Full-text

Initial and Long-Term Results of Endovascular Therapy for Chronic Total Occlusion of the Subclavian Artery

CardioVascular and Interventional Radiology ◽

10.1007/s00270-011-0144-8 ◽

2011 ◽

Vol 35 (2) ◽

pp. 255-262 ◽

Cited By ~ 31

Author(s):

Srdjan Babic ◽

Dragan Sagic ◽

Djordje Radak ◽

Zelimir Antonic ◽

Petar Otasevic ◽

...

Keyword(s):

Subclavian Artery ◽

Endovascular Therapy ◽

Chronic Total Occlusion ◽

Long Term Results ◽

Total Occlusion

Download Full-text

Prevalence of Subclavian Artery Stenosis in Patients With Coronary Artery Disease

10.21203/rs.3.rs-56393/v1 ◽

2020 ◽

Author(s):

Assem AbdelAziz Hashad ◽

Abdalla Elagha

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Vertebral Artery ◽

Doppler Ultrasound ◽

Subclavian Artery ◽

Screening Method ◽

Arterial Disease ◽

Artery Stenosis ◽

Subclavian Artery Stenosis ◽

Artery Disease

Abstract Background : Atherosclerosis is the most common and serious vascular disease that affects both the brain and the heart .(1) Subclavian stenosis/occlusion is a marker for atherosclerotic disease (eg, carotid, coronary & lower extremity arteries) and future adverse cardiovascular events. (2) In this study, we identified the prevalence of subclavian artery stenosis in patients presented with coronary artery disease (CAD) through changes in the Doppler tracing of vertebral arteries that appear to represent a clue of subclavian artery stenosis.Methods: On the basis of extracranial Doppler ultrasound & supplementary intracranial Doppler ultrasound, we assessed the pattern of Doppler waveform in both carotid & vertebrobasilar systems among 100 consecutive patients who were hospitalized for CAD in the cardiovascular department.Results: Among 100 consecutive CAD patients studied, we identified stenosis and occlusion of subclavian artery in 5 patients (5%). In those patients, subclavian arterial disease was indirectly discovered by changes in Doppler waveforms of vertebral artery. Conclusions: Prevalence of subclavian artery stenosis in patients with CAD is 5%. Changes in the pulse contour of antegrade vertebral artery Doppler waveforms seem to represent a good screening method for subclavian steal phenomena.

Download Full-text

Transposition of Subclavian Artery – Is It the Appropriate Choice?

PRILOZI ◽

10.1515/prilozi-2017-0006 ◽

2017 ◽

Vol 38 (1) ◽

pp. 47-51

Author(s):

Nikola Lazovski ◽

Sasko Jovev ◽

Dusan Babic ◽

Srdjan Babic ◽

Omer Dzemali

Keyword(s):

Surgical Treatment ◽

Treatment Failure ◽

Endovascular Treatment ◽

Subclavian Artery ◽

Artery Occlusion ◽

Long Term Results ◽

Duplex Scan ◽

Subclavian Artery Occlusion ◽

Artery Disease

Abstract Introduction: To present patients with symptomatic subclavian artery disease and treatment possibility. Case report: A 53-year-old female was admitted with vertigo and left arm claudication. Duplex-scan and MSCT arteriography verified subclavian artery occlusion. After the endovascular treatment failure, the patient was switched to surgical treatment - subclavian artery transposition. After the successful surgical treatment, the patient was discharged on the second postoperative day. If the patient is a candidate for surgery, the literature review shows good initial and long-term results after the subclavian artery transposition, and emphasizes this technique as superior. Conclusion: Subclavian carotid transposition is a safe and effective method of treatment in patients after endovascular treatment failure or other indication. Also, the surgical treatment is technically demanding because of the difficult access to the vessel origin, and it requires experienced surgeons.

Download Full-text