Yajun Liu1, Jian Zhang2, Yongquan Gu1, Lianrui Guo1, Jianxin Li1. 1. Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China. 2. Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China. Electronic address: drzhangjian2000@126.com.
Abstract
BACKGROUND: Endovascular therapy is a feasible option for total occlusion of the subclavian artery. The purpose of this study was to evaluate the effectiveness of stenting therapy by comparing it with that of surgical treatment in patients with total subclavian artery occlusion. METHODS: Between May 2007 and October 2013, 52 stents were placed in 67 patients who underwent endovascular therapy for the treatment of total atherosclerosis subclavian artery occlusion. During the same period, 21 patients underwent bypass surgery. All patients were followed at 3, 6, and 12 months after treatment and annually thereafter. RESULTS: Technical success was achieved in 77.6% patients in the endovascular group, while clinical success was achieved in 74.6%. Technical failure was noted in 15 patients, while the symptoms failed to resolve in 2. The rate of primary patency was 98.2% at 12 months, 94.3% at 24 months, and 92.1% at 3 years. Significant recurrent obstruction developed in 5 patients. No complications were observed in 5 patients with right side occlusion in whom embolic protection filters were used. Meanwhile, the technical success rate was 100% in the surgery group. One patient developed a major ischemic stroke during surgery (4.8%). The rate of primary patency was 100% at 12 months, 96.3% at 24 months, and 93.1% at 3 years. CONCLUSIONS: When performed by skilled surgeons, percutaneous revascularization with primary stenting is a safe and effective therapy for symptomatic total occlusion of the proximal subclavian artery. However, we recommend the use of embolic protection devices during the treatment of right side occlusions. Otherwise, surgery may be the best choice.
BACKGROUND: Endovascular therapy is a feasible option for total occlusion of the subclavian artery. The purpose of this study was to evaluate the effectiveness of stenting therapy by comparing it with that of surgical treatment in patients with total subclavian artery occlusion. METHODS: Between May 2007 and October 2013, 52 stents were placed in 67 patients who underwent endovascular therapy for the treatment of total atherosclerosis subclavian artery occlusion. During the same period, 21 patients underwent bypass surgery. All patients were followed at 3, 6, and 12 months after treatment and annually thereafter. RESULTS: Technical success was achieved in 77.6% patients in the endovascular group, while clinical success was achieved in 74.6%. Technical failure was noted in 15 patients, while the symptoms failed to resolve in 2. The rate of primary patency was 98.2% at 12 months, 94.3% at 24 months, and 92.1% at 3 years. Significant recurrent obstruction developed in 5 patients. No complications were observed in 5 patients with right side occlusion in whom embolic protection filters were used. Meanwhile, the technical success rate was 100% in the surgery group. One patient developed a major ischemic stroke during surgery (4.8%). The rate of primary patency was 100% at 12 months, 96.3% at 24 months, and 93.1% at 3 years. CONCLUSIONS: When performed by skilled surgeons, percutaneous revascularization with primary stenting is a safe and effective therapy for symptomatic total occlusion of the proximal subclavian artery. However, we recommend the use of embolic protection devices during the treatment of right side occlusions. Otherwise, surgery may be the best choice.
Authors: Rami Fakih; Sudeepta Dandapat; Alan Mendez-Ruiz; Aldo A Mendez; Mudassir Farooqui; Cynthia Zevallos; Darko Quispe Orozco; David Hasan; James Rossen; Edgar A Samaniego; Colin Derdeyn; Santiago Ortega-Gutierrez Journal: Front Neurol Date: 2020-10-22 Impact factor: 4.003