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Clinical research of angioplasty and stenting in the treatment for symptomatic severe subclavian artery stenosis  [cached]
WANG Lei-bo,ZHAO Xiao-jing,LUO Wei-juan,LIU Lian
Chinese Journal of Contemporary Neurology and Neurosurgery , 2013, DOI: 10.3969/j.issn.1672-6731.2013.03.015
Abstract: Background The major clinical presentation of severe subclavian artery stenosis is subclavian steal syndrome (SSS). At present, stent implantation has become a promising method for this disease. The aim of this article is to investigate the effectiveness and safeness of stent implantation in the treatment for symptomatic severe subclavian artery stenosis. Methods Clinical data of 20 patients with symptomatic severe subclavian artery stenosis treated via angioplasty and stenting from June 2012 to November 2012 were retrospectively analyzed. Results The procedure was technically successful in all of the 20 cases. Postoperative digital subtraction angiography (DSA) suggested the residual ratio of subclavian artery stenosis was < 20%. Straight-forward blood flow in vertebral artery, disappeared subclavian steal symptom and fluent blood flow in intracranial segment of ipsilateral vertebral artery were also seen. After procedure no stent-related complications were found. During the follow-up study from 10 days to 6 months, vessel ultrasound and computed tomography angiography (CTA) showed no in-stent restenosis, vessels with good form and fluent blood flow. Conclusion Percutaneous angioplasty and stenting is a minimally invasive, safe and effective method in the treatment for severe subclavian artery stenosis.
Coronary Subclavian Steal Syndrome Unamenable to Angioplasty Successfully Managed with Subclavian-Subclavian Bypass
Saad Tariq,Swosty Tuladhar,Edward Wingfield,Honesto Poblete
Case Reports in Vascular Medicine , 2012, DOI: 10.1155/2012/784231
Abstract: Purpose. Coronary-subclavian steal syndrome (CSSS) is defined as a reversal of flow in a previously constructed internal mammary artery (IMA) coronary conduit, producing myocardial ischemia. We present a case of CSSS which could not be ameliorated with endovascular therapy and necessitated a subclavian-subclavian bypass. Case Report. 80-year-old Caucasian male with history of CABG presented with syncope. He had absent left-sided radial pulse with blood pressure being 60/40 on left arm and 130/80 on the right. He underwent cardiac catheterization for NSTEMI which showed patent left internal mammary artery graft to left anterior descending coronary artery with retrograde flow, and diagnosis of coronary subclavian steal syndrome was made. Complete occlusion of proximal left subclavian artery was identified. Percutaneous angioplasty failed because of calcified plaque causing 100% occlusion. Carotid doppler showed bilateral carotid artery disease. He finally underwent subclavian-subclavian bypass which resolved his condition. Conclusion. Subclavian-subclavian bypass is a successful alternative to carotid-subclavian bypass for management of CSSS especially with concomitant critical carotid artery atherosclerotic disease.
Coronary Subclavian Steal Syndrome Unamenable to Angioplasty Successfully Managed with Subclavian-Subclavian Bypass  [PDF]
Saad Tariq,Swosty Tuladhar,Edward Wingfield,Honesto Poblete
Case Reports in Vascular Medicine , 2012, DOI: 10.1155/2012/784231
Abstract: Purpose. Coronary-subclavian steal syndrome (CSSS) is defined as a reversal of flow in a previously constructed internal mammary artery (IMA) coronary conduit, producing myocardial ischemia. We present a case of CSSS which could not be ameliorated with endovascular therapy and necessitated a subclavian-subclavian bypass. Case Report. 80-year-old Caucasian male with history of CABG presented with syncope. He had absent left-sided radial pulse with blood pressure being 60/40 on left arm and 130/80 on the right. He underwent cardiac catheterization for NSTEMI which showed patent left internal mammary artery graft to left anterior descending coronary artery with retrograde flow, and diagnosis of coronary subclavian steal syndrome was made. Complete occlusion of proximal left subclavian artery was identified. Percutaneous angioplasty failed because of calcified plaque causing 100% occlusion. Carotid doppler showed bilateral carotid artery disease. He finally underwent subclavian-subclavian bypass which resolved his condition. Conclusion. Subclavian-subclavian bypass is a successful alternative to carotid-subclavian bypass for management of CSSS especially with concomitant critical carotid artery atherosclerotic disease. 1. Introduction Coronary-subclavian steal syndrome (CSSS) is defined as a reversal of flow in a previously constructed internal mammary artery (IMA) coronary conduit, producing myocardial ischemia. This is typically caused by proximal subclavian artery stenosis in patients with an ipsilateral IMA coronary conduit [1]. This condition may have broad spectrum of symptoms related to alteration in flow in coronary circuit as well as changes in cerebrovascular hemodynamics. Posterior cerebral circulation [2] can be adversely affected as well as the ipsilateral brachial artery. CSSS may be treated endoscopically with stents if the lesion can be ameliorated, otherwise surgery is required which may include aortosubclavian bypass [3], carotid subclavian bypass [4], or axilloaxillary [5] bypass techniques. We are presenting a case which had an unusual presentation of CSSS, denied any chest pains to the presenting physician, and had mainly syncopal symptoms. He had a complicated hospital course limiting his medical management but finally had a successful subclavian-subclavian bypass. 2. Case Report An 80-year-old Caucasian male with history of coronary artery bypass graft (CABG) was brought to emergency room (ER) after being found unconscious at home. Detailed examination showed that left radial pulse was markedly diminished compared to right side and
The Effect of Coronary Risk Factors on Restenosis after Transluminal Coronary Angioplasty and Stenting
Cetin GUL,Mustafa YILDIZ,Ersan TATLI,Fatih OZCELIK
Trakya Universitesi Tip Fakultesi Dergisi , 2002,
Abstract: Objectives: We investigated the relationship between coronary risk factors (age, gender, smoking, diabetes mellitus, hypertension, family history, and hypercholesterolemia) and the development of restenosis after percutaneous transluminal coronary interventions. Patients and Methods: A total of 162 patients underwent successful percutaneous transluminal coronary angioplasty with or without stenting. Follow-up coronary angiograms were performed in 107 patients (15 females, 92 males; mean age 55.5 years, range 39 to 77 years) after a mean of 184 days. Logistic regression was used for the analysis of the associations between the variables and restenosis. Results: Restenosis was detected in 47 patients (39%). Age, gender, smoking, hypertension, hypercholesterolemia, family history, a history of previous myocardial infarction, ejection fraction, and the degree and location of stenosis were not found as significant variables in the development of restenosis. However, restenosis was significantly correlated with diabetes mellitus (-2 log likelihood 28.28, p=0.0002). The rate of restenosis was significantly lower in the stent group (n=56, 52%) (p<0.01). Conclusion: Diabetes mellitus presents as the most significant risk factor in the development of restenosis after coronary angioplasty and stenting.
Coronary-Subclavian Steal Syndrome: Percutaneous Approach  [PDF]
Carina Machado,Luís Raposo,Sílvio Leal,Pedro Araújo Gon？alves,Henrique Mesquita Gabriel,Rui Campante Teles,Manuel Sousa Almeida,Miguel Mendes
Case Reports in Cardiology , 2013, DOI: 10.1155/2013/757423
Abstract: Coronary subclavian steal syndrome is a rare ischemic cause in patients after myocardial revascularization surgery. Subclavian artery stenosis or compression proximal to the internal mammary artery graft is the underlying cause. The authors present a clinical case of a patient with previous history of non-ST elevation myocardial infarction, triple coronary bypass, and effort angina since the surgery, with a positive ischemic test. Coronary angiography revealed a significant stenosis of the left subclavian artery, proximal to the internal mammary graft. 1. Introduction The coronary subclavian steal syndrome (CSSS) was first described in 1974 and is caused by retrograde or insufficient blood flow through the internal mammary artery graft, with subsequent myocardial ischemia. Proximal atherosclerotic stenosis of the ipsilateral subclavian artery is the most frequent cause [1]. Although most cases of angina after coronary bypass graft surgery (CABG) are due to native-vessel or graft atherosclerotic disease progression, this syndrome should not be disregarded [2]. The traditional approach for this problem is surgical revascularization of the subclavian artery with a bypass graft, but percutaneous transluminal subclavian artery angioplasty has emerged as an effective alternative to surgery and it is now a widely accepted method of treating symptomatic subclavian steal syndrome. 2. Case Report The authors present the case report of a 69-year-old male patient with several cardiovascular risk factors (hypertension, hyperlipidaemia, and previous smoking) and history of coronary artery bypass grafting (CABG) 6 years before when the left internal mammary artery (LIMA) was grafted to the left anterior descending artery (LAD), saphenous vein conduit was grafted to posterior descendent artery and left radial artery grafted to the intermediary branch. No medical imaging of the aortic arch and its branches was performed before cardiac surgery. He had recurrence of angina following the surgery (CCS class II) mainly when exerting the upper limbs. His therapy was adjusted and remained only mildly symptomatic until 2011 when he was referred to for coronary angiography because of gradually worsening exertional angina with no response to medical therapy. There were no neurological or claudication complaints. Physical examination only showed an II/VI systolic murmur. Basal EKG and blood analysis were unremarkable. On the transthoracic echocardiogram, there was only mild aortic sclerosis and good global and segmental systolic left ventricle function. He had a positive exercise
Subclavian artery angioplasty in elderly patients with coronary-subclavian steal syndrome: preliminary comparison between a modified brachial technique and the standard femoral approach
Gianluca Rigatelli,Paolo Cardaioli,Massimo Giordan,Stefano Panin,Laura Oliva,Tranquillo Milan,Loris Roncon,
Gianluca Rigatelli,Paolo Cardaioli,Massimo Giordan,Stefano Panin,Laura Oliv,Tranquillo Milan,Loris Roncon
老年心脏病学杂志(英文版) , 2007,
Abstract: Background and Objective Elderly patients who have been submitted to coronary bypass grafting with the left internal mammary artery (LIMA) may develop a coronary-subclavian steal syndrome because of a left subclavian artery (LSA) stenosis. Usually stenting of LSA is performed by the standard femoral route with guiding catheter technique, but this technique can be particularly difficult in elderly patients who often have iliac-femoral kinking and aortic tortuosity. We compared a new "ad hoc" brachial artery approach technique with the standard guiding catheter technique through the femoral access. Methods Between January 2005 and September 2006, four patients underwent LSA stenting using the left brachial artery access obtained with a 6F or 7F 45-cm-long valved anti-kinking sheath as the Super Arrow Flex sheath (Arrow International, PA, USA). The sheath was positioned just before the LIMA graft ostium and a 0.035 inch 260-cm-long Storq guidewire (Cordis Inc., Johnson & Johnson, Warren, NJ) was advanced across the lesion to the descending aorta. A balloon-expandable Genesis (Cordis Inc., Johnson & Johnson, Warren, NJ) endovascular stent was easily deployed, and the correct position was checked by direct contrast injection through the long sheath. This small group of patients has been compared to a group of 5 age-matched patients with coronary steal syndrome in whom the procedure has been performed with standard technique including femoral approach and guide catheter. Results The procedure was successful in all patients; vertebral and LIMA ostia remained patent in all cases. In the control group, cannulation of the subclavian artery was difficult in two cases, while one patient developed a groin hematoma. Mean pretreatment gradient was 32 mm Hg with a range of 25 to 40 mm Hg (34 mmHg, range 26-43, in the control group, P=0.87) and fell to 2 mm Hg with a range of 0 to 4 mm Hg (3.1 mmHg, range 0 to 5, P=0.89) posttreatment. Mean contrast dose was 60±16 ml (138±26 ml in the control group, P＞0.01), whereas mean fluoroscopy and procedural time were 5.7±1.6 minutes (10.8±1.0 minutes in the control group, P＞0.01) and 15.7±6.3 minutes (28±7.1 minutes in the control group, P＞0.01). At a mean follow-up of 10±3.2 months all patients are alive and free from angina and residual induced ischemia. Conclusions Our brief study suggested that brachial artery access be considered the optimal route to treat coronary-subclavian steal syndrome in elderly patients because of clear advantages; these included no manipulation of catheter to cannulate the artery, perfect coaxial position of the catheter at the site of LSA stenosis, clear visualization of the LIMA and vertebral ostia, and easy access to these vessels in case of plaque shifting or embolic protection device deployment.
Percutaneous transluminal angioplasty and stenting of carotid arteries: Early results
？oli？ Mom？ilo,Jadranin Dragica,Markovi？ Dejan,Davidovi？ Lazar
Srpski Arhiv za Celokupno Lekarstvo , 2008, DOI: 10.2298/sarh0810494c
Abstract: INTRODUCTION Treatment of carotid stenosis could be surgical: eversion endarterectomy, conventional endarterectomy and patch-plasty, resection with graft interposition and bypass procedure or, in the past few years, carotid artery angioplasty (PTA) with stent implantation. OBJECTIVE The aim of this study is to present early results of carotid artery angioplasty and stenting, as well as to identify indications for this procedure. METHOD Twenty-three patients with stenosis of internal carotid artery were included in the prospective study which was performed in the period from July 2006 to July 2007. For PTA and stenting of the carotid artery we used Balloon dilatation catheter Ultra-softTM SV and Carotid WallstentTM MonorailTM. During the procedure, brain protection by embolic protection system Filter Wire EZ was essentially performed. Descriptive statistical methods were performed to present and describe the patient characteristics, risk factors and results. RESULTS 23 patients were examined. In four (17.39%) cases there was asymptomatic, while in 19 (82.61%) there was symptomatic homodynamic significant stenosis of the internal carotid artery. Four of these 19 patients (17.39%) had late restenosis following carotid endarterectomy, four (17.39%) important respiratory failure, and 11 (47.83%) important heart disease. Patients were followed up for the first 30 postopertive days. In that period, there were no mortality and no needs for surgical conversions. In one case (4.35%), residual stenosis of 30% remained. Two patients (8.70%) had TIA and one (4.35%) had CVI. CONCLUSION Main indications for PTA and stenting of carotid arteries are: surgically inaccessible lesions (at or above C2; or subclavial); radiation-induced carotid stenosis; prior ispilateral radical neck dissection; prior carotid endarterectomy (restenosis), severe cardiac and pulmonary conditions. Limitations and contraindications to carotid angioplasty and stentning include: significant peripheral occlusive diseases; unfavorable aortic arch anatomy; severe tortuosity of the common and internal carotid artery; severely calcified stenosis, lesions containing fresh thrombus; stenosis longer than 2 cm; critical (>99%) stenosis; associated carotid artery aneurysm; contrast-related issues and severe aortic valve stenosis.
A case of acquired right-sided subclavian steal syndrome successfully treated with stenting using brachial approach  [PDF]
Dragan Dragi？evi？, Maja ？kori？, Kre？imir Koli？, Marina Titli？
Case Reports in Clinical Medicine (CRCM) , 2014, DOI: 10.4236/crcm.2014.32017
Abstract:

Subclavian steal syndrome (SSS) is defined as a group of symptoms that arise from reversed blood flow in the ipsilateral vertebral artery. It is the consequence of proximal occlusion or high-grade stenosis of the subclavian artery. The subclavian obstructive lesions are mostly located in the proximal segment of the subclavian artery and predominantly on the left side. In contrast, there are only a small number of patients that present with right-sided symptoms and even fewer with bilateral symptoms. Endovascular therapy of occlusions and high-grade stenosis of subclavian artery proximal to the origin of the vertebral artery becomes an established therapy in last two decades. We report a case of successful endovascular treatment of right-sided subclavian steal and high-grade (80%) right subclavian artery stenosis due to atherosclerotic occlusive disease with balloon-expandable stent using brachial approach.

Coronary Subclavian Steal Syndrome Causing Acute Myocardial Infarction in a Patient Undergoing Coronary-Artery Bypass Grafting
Jiri Mandak,Miroslav Lojik,Martin Tuna,James Lago Chek
Case Reports in Medicine , 2012, DOI: 10.1155/2012/798356
Abstract: Coronary subclavian steal syndrome with retrograde blood flow in the left internal mammary-coronary bypass graft is a rare but severe complication of cardiac surgery. The authors present a case of a 68-year-old man after coronary-artery bypass grafting using an internal mammary artery. He had been suffering from angina pectoris for the last several years before surgery. The patient was resuscitated at home by emergency medical service because of primary ventricular fibrillation due to an acute myocardial infarction 5 years after surgery. An occlusion of the left subclavian artery with the retrograde blood flow in the left internal mammary coronary bypass was found. This could have been the cause of insufficiency in coronary blood flow and ischemia of the myocardial muscle. The subclavian artery occlusion was successfully treated with percutaneous transluminal angioplasty and implantation of 2 stents. The patient remained free of any symptoms 2 years after this procedure.
The use of primary stenting or balloon percutaneous transluminal coronary angioplasty for the treatment of acutely occluded saphenous vein grafts. Results from the Brazilian National Registry - CENIC
Mattos, Luiz Alberto;Sousa, Amanda G.M.R.;Campos Neto, Cantídio de Moura;Labrunie, André;Alves, Cláudia Rodrigues;Feres, Fausto;Soares Neto, Milton Macedo;Saad, Jamil;
Arquivos Brasileiros de Cardiologia , 2001, DOI: 10.1590/S0066-782X2001000600006
Abstract: objective: we conducted a comparative analysis of the in-hospital outcomes of patients who underwent primary percutaneous transluminal angioplasty (ptca) or stent implantation because of an acute myocardial infarction (ami) related to an acute vein graft occlusion. methods: since 1991 the brazilian society of hemodynamic and interventional cardiology has maintained a large database (cenic). from these, we selected all consecutive patients, who underwent primary ptca or stenting in the first 24 hours of ami, with the target vessel being an occluded vein graft. immediate results and major coronary events occurring up until hospital discharge were analyzed. results: during this period, 5,932 patients underwent primary ptca or stenting; 158 (3%) of the procedures were performed because of an acute vein graft occlusion. stenting was performed in 74 (47%) patients. patients treated with stents had a higher success rate and lower mean residual stenosis compared with those who underwent primary balloon ptca. the incidence of reinfarction and death were similar for stenting and balloon ptca. conclusion: primary percutaneous treatment of ami related to acute vein graft occlusion is still an uncommon practice. primary stenting improved luminal diameter and offered higher rates of success; however, this strategy did not reduce the in-hospital reinfarction and death rate, compared with that occurring with ptca treatment.
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