ABSTRACT
BACKGROUND: The subclavian arteries are two major arteries of the upper chest, below the collar bone, which come from the arch of the aorta. Endovascular treatment for stenosis of the subclavian arteries includes angioplasty alone, and with stenting. There is insufficient evidence to guide the use of stents following angioplasty for subclavian artery stenosis. This is the second update of a review first published in 2011. OBJECTIVES: The aim of this review was to determine whether stenting was more effective than angioplasty alone for stenosis of the subclavian artery. SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and LILACS databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 2 February 2021. SELECTION CRITERIA: We searched for randomised controlled trials of endovascular treatment of subclavian artery lesions that compared angioplasty alone and stent implantation. DATA COLLECTION AND ANALYSIS: Two review authors independently evaluated studies to assess eligibility. Discrepancies were resolved by discussion. If there was no agreement, we asked a third review author to assess the study for inclusion. We planned to undertake data collection and analysis in accordance with recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions, and assess the certainty of the evidence using a GRADE approach. MAIN RESULTS: To date, we have not identified any completed or ongoing randomised controlled trials that compare percutaneous transluminal angioplasty and stenting for subclavian artery stenosis. AUTHORS' CONCLUSIONS: There is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.
Subject(s)
Subclavian Steal Syndrome , Angioplasty , Constriction, Pathologic/therapy , Humans , Stents , Subclavian Steal Syndrome/therapy , Systematic Reviews as TopicABSTRACT
Subclavian steal syndrome is a group of symptoms resulting fromretrograde flow in the vertebral artery, "stealing" blood from the posterior intracranial circulation and other territories, caused by stenosis or occlusion of the subclavian artery proximal to the origin of the same vertebral artery, or even of the brachiocephalic trunk. Most of the time, it is an incidental finding in patients with other conditions or cerebrovascular risk factors. We report a series of 29 patients with an angiographic diagnosis, in which 7 received treatment (all endovascular), all with symptoms directly related to this condition. Advanced age, systemic arterial hypertension, diabetes mellitus, smoking and stroke were comorbidities frequently related. Six patients improved completely after the procedure and one remained with vertigo.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Subclavian Artery/abnormalities , Subclavian Steal Syndrome/physiopathology , Subclavian Steal Syndrome/therapy , Subclavian Steal Syndrome/diagnostic imaging , Brazil/epidemiology , Medical Records , Epidemiology, Descriptive , Cross-Sectional Studies/methods , Data Interpretation, Statistical , Angioplasty/methodsABSTRACT
When the proximal occlusion or stenosis of the subclavian or of the brachiocephalic artery may require distal arterial filling through reversal flow from the vertebral artery, causing clinically significant blood supply reduction to the brainstem, it is called subclavian steal syndrome (SSS). We report a 54-year-old male patient who presented with multiple episodes of syncopes and vascular claudication due to right SSS. He underwent an angioplasty, evolving with complete improvement of the symptoms. We review the clinical presentation, the diagnosticmethods, and the treatment options of the disease.
Subject(s)
Humans , Male , Middle Aged , Subclavian Artery/abnormalities , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/physiopathology , Subclavian Steal Syndrome/therapy , Syncope , Endovascular Procedures/methodsABSTRACT
A síndrome do roubo da subclávia refere-se a uma desordem vascular na qual ocorre inversão do fluxo de sangue da artéria vertebral ipsilateral, decorrente de uma estenose proximal à sua origem, geralmente uma oclusão da artéria subclávia ou, mais raramente, do troncobraquiocefálico. É uma doença relativamente rara, relatadaem aproximadamente 6% dos pacientes assintomáticos com sopros cervicais. O Doppler pulsado (PW) é útil na análiseda artéria vertebral, registrando informações capazes de identificar a presença da Síndrome do Roubo da Subclávia. Com base nas alterações hemodinâmicas da artéria vertebralavaliadas pelo estudo com Doppler espectral, pode ser classificada nos tipos 1 (oculto), 2 (intermitente ou parcial)e 3 (completo). Com o advento da angioplastia transluminal percutânea e, em seguida, dos stents, muitos advogam essa combinação de procedimentos como o tratamento de escolha dos casos sintomático dessa síndrome.
Subject(s)
Humans , Vertebral Artery/physiopathology , Subclavian Steal Syndrome/therapy , Ultrasonography, Doppler, Pulsed/methods , Angiography/methods , Risk Factors , StentsABSTRACT
Paciente femenina de 46 años de edad, con antecedentes de hipertensión arterial y fumadora habitual. Desde hace 2 años presenta episodios aislados y breves de vértigos, inestabilidad postural, sensación de desfallecimiento sin alteraciones de la conciencia, después de realizar ejercicios del brazo izquierdo. El examen neurológico muestra asimetría de pulsos carotídeos y radiales. El doppler extracraneal reveló alteraciones ateroscleróticas en ambos ejes carotídeos, con estenosis derecha del 50 porciento, disminución del flujo de la arteria vertebral izquierda y obstrucción proximal de la arteria subclavia izquierda proximalmente. El síndrome del robo de la subclavia es una entidad poco frecuente, su diagnóstico es clínico y se demuestra mediante doppler o angiografía. El tratamiento debe ser decidido individualmente en cada caso(AU)
A 46 year-old female patient with a history of hypertension and regular smoker complained of isolated and brief episodes of dizziness, postural instability, faint feeling without altered consciousness, after exercise the left arm for 2 years. Her neurological examination showed asymmetry of carotid and radial pulses. Her extracranial doppler revealed carotid atherosclerotic changes in both axes, with 50 percent right stenosis, decreased flow of the proximal left vertebral artery and obstruction of the proximal left subclavian artery. Subclavian Steal Syndrome is a rare condition. Its diagnosis is clinical and it is demonstrated by Doppler or angiography. Treatment should be determined individually in each case(AU)
Subject(s)
Humans , Female , Middle Aged , Hypertension/diagnosis , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/therapy , Vertebral Artery/injuries , Ultrasonography, Doppler, Transcranial/methodsABSTRACT
Paciente femenina de 46 años de edad, con antecedentes de hipertensión arterial y fumadora habitual. Desde hace 2 años presenta episodios aislados y breves de vértigos, inestabilidad postural, sensación de desfallecimiento sin alteraciones de la conciencia, después de realizar ejercicios del brazo izquierdo. El examen neurológico muestra asimetría de pulsos carotídeos y radiales. El doppler extracraneal reveló alteraciones ateroscleróticas en ambos ejes carotídeos, con estenosis derecha del 50 %, disminución del flujo de la arteria vertebral izquierda y obstrucción proximal de la arteria subclavia izquierda proximalmente. El síndrome del robo de la subclavia es una entidad poco frecuente, su diagnóstico es clínico y se demuestra mediante doppler o angiografía. El tratamiento debe ser decidido individualmente en cada caso.
A 46 year-old female patient with a history of hypertension and regular smoker complained of isolated and brief episodes of dizziness, postural instability, faint feeling without altered consciousness, after exercise the left arm for 2 years. Her neurological examination showed asymmetry of carotid and radial pulses. Her extracranial doppler revealed carotid atherosclerotic changes in both axes, with 50 % right stenosis, decreased flow of the proximal left vertebral artery and obstruction of the proximal left subclavian artery. Subclavian Steal Syndrome is a rare condition. Its diagnosis is clinical and it is demonstrated by Doppler or angiography. Treatment should be determined individually in each case.
Subject(s)
Middle Aged , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/therapy , Vertebral Artery/injuries , Ultrasonography, Doppler, Transcranial/methods , Hypertension/diagnosisABSTRACT
BACKGROUND: There is insufficient evidence to guide stent usage following angioplasty in subclavian artery stenosis. This is an update of a review first published in 2011. OBJECTIVES: The aim of this review was to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery. SEARCH METHODS: For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched February 2014) and CENTRAL (2014, Issue 1). There was no restriction on language. SELECTION CRITERIA: Randomised controlled trials of endovascular treatment of subclavian artery lesions comparing angioplasty alone and stent implantation. DATA COLLECTION AND ANALYSIS: Two authors independently evaluated studies to assess eligibility. Discrepancies were resolved by discussion. If there was no agreement, the third author was asked to assess the study for inclusion. MAIN RESULTS: To date we have not identified any completed or ongoing randomised controlled trials comparing percutaneous transluminal angioplasty and stenting for subclavian artery stenosis. AUTHORS' CONCLUSIONS: There is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.
Subject(s)
Angioplasty , Stents , Subclavian Steal Syndrome/therapy , HumansABSTRACT
BACKGROUND: There is insufficient evidence to guide stent usage following angioplasty in subclavian artery stenosis. OBJECTIVES: The aim of this review was to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery. SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched August 2011) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3). In addition, the authors searched the MEDLINE, EMBASE and LILACS databases, and handsearched relevant journals. Informal enquiries were made with the major stent device manufacturers to obtain information on unpublished data and any ongoing trials. There was no restriction on language. SELECTION CRITERIA: Randomized controlled trials of endovascular treatment of subclavian artery lesions comparing angioplasty alone and stent implantation. DATA COLLECTION AND ANALYSIS: Two authors independently evaluated studies to assess eligibility. Discrepancies were resolved by discussion. If there was no agreement, the third author was asked to assess the study for inclusion. MAIN RESULTS: To date we have not identified any completed or ongoing randomized controlled trials comparing percutaneous transluminal angioplasty and stenting for subclavian artery stenosis. AUTHORS' CONCLUSIONS: There is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.
Subject(s)
Angioplasty , Stents , Subclavian Steal Syndrome/therapy , HumansABSTRACT
It is the obstruction or estenosis of an arterys proximal segment, which is close to the origin the vertebral artery. This causes blood flow inversion within the ipsilateral artery. An increase in the irrigation demands of the artery may cause TIA in the posterior circulation, which is denominated as subclavian steal syndrome. In these cases, contralateral circulation may contribute to prevention of several events due to hypoperfusion. In the case in which a subclavian estenosis accompanied by alteration in blood flow in the contralateral artery arises, symptoms corresponding to the irrigation area affected will be generated.
Se denomina de esta manera a la obstrucción o estenosis del segmento proximal de dicha arteria, cercano al origen de la arteria vertebral, lo que provoca inversión del flujo de la arteria vertebral ipsilateral. Un incremento en la demanda de la irrigación de la arteria vertebral puede provocar un AIT en la circulación posterior, o robo de la subclavia. De acontecer esto, existe el aporte de la circulación contra lateral que puede prevenir los diversos eventos debido a la hipoperfusión. De coexistir una estenosis de la subclavia con alteraciones de la circulación contralateral, se generaran los síntomas respectivos al área de irrigación afectada.
Subject(s)
Humans , Male , Adult , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/therapy , Subclavian Artery , Vertebral ArteryABSTRACT
We report a patient with left subclavian artery stenosis in whom the internal thoracic artery (ITA) had been used as a coronary bypass. She presented with symptomatic myocardial and brain ischemia resulting from coronary-subclavian steal syndrome and was successfully treated with angioplasty and stenting.
Subject(s)
Angioplasty, Balloon/methods , Arterial Occlusive Diseases/therapy , Graft Occlusion, Vascular/therapy , Subclavian Artery/pathology , Subclavian Steal Syndrome/etiology , Subclavian Steal Syndrome/therapy , Aged , Arterial Occlusive Diseases/diagnostic imaging , Coronary Angiography , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/methods , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/surgery , Dobutamine , Echocardiography, Doppler , Exercise Test , Female , Follow-Up Studies , Graft Occlusion, Vascular/diagnostic imaging , Humans , Risk Assessment , Severity of Illness Index , Stents , Subclavian Artery/diagnostic imaging , Subclavian Steal Syndrome/diagnostic imaging , Treatment Outcome , Vascular Patency/physiologyABSTRACT
Subclavian steal syndrome refers to the association of neurological symptoms related to vertebrobasilar insufficiency and the phenomenon of subclavian steal. We report the case of a 63 year-old male patient that presented subclavian steal syndrome and severe proximal (80%) stenosis of the left subclavian artery. The patient was submitted to percutaneous transluminal angioplasty and stenting on the left SA. The procedure was well tolerated and immediately afterwards, there was complete remission of the symptoms and of the phenomenon of subclavian steal evaluated by angiography and transcranial doppler. We propose that percutaneous transluminal angioplasty with stenting placement is a good therapeutic option for subclavian steal syndrome.
Subject(s)
Angioplasty, Balloon , Stents , Subclavian Artery , Subclavian Steal Syndrome/therapy , Coronary Artery Bypass , Coronary Disease/complications , Humans , Male , Middle Aged , Radiography , Subclavian Artery/diagnostic imaging , Subclavian Steal Syndrome/complicationsABSTRACT
Subclavian steal syndrome refers to the association of neurological symptoms related to vertebrobasilar insufficiency and the phenomenon of subclavian steal. We report the case of a 63 year-old male patient that presented subclavian steal syndrome and severe proximal (80 percent) stenosis of the left subclavian artery. The patient was submitted to percutaneous transluminal angioplasty and stenting on the left SA. The procedure was well tolerated and immediately afterwards, there was complete remission of the symptoms and of the phenomenon of subclavian steal evaluated by angiography and transcranial doppler. We propose that percutaneous transluminal angioplasty with stenting placement is a good therapeutic option for subclavian steal syndrome
Subject(s)
Humans , Male , Middle Aged , Angioplasty, Balloon , Stents , Subclavian Artery , Subclavian Steal Syndrome/therapy , Coronary Artery Bypass , Coronary Disease , Subclavian Artery , Subclavian Steal Syndrome/complicationsABSTRACT
Os autores apresentam o caso de um paciente de 65 anos de idade, diabético e coronariopata grave, submetido à revascularizaçao miocárdica há 10 anos, com duas pontes de safena (ocluída) e uma ponte de mamária pérvia, com sintomas de hipofluxo. Procurou o serviço de emergência do Hospital de Base com clínica de angina instável e síndrome do roubo de artéria subclávia. Foi submetido a estudo angiográfico, que confirmou estenose de artéria carótida esquerda e de artéria subclávia direita obstruçao da artéria subclávia esquerda na sua origem. Devido ao risco cirúrgico alto foi proposta angioplastia transluminal que proporcionou a resoluçao do quadro clínico.
Subject(s)
Humans , Male , Aged , Internal Mammary-Coronary Artery Anastomosis , Angioplasty, Balloon , Subclavian Steal Syndrome/therapy , Subclavian ArteryABSTRACT
A síndrome do roubo da subclávia é doença cérebro-vascular incomum, que pode ser tratada por meio de técnicas endovasculares. São apresentados três casos dessa entidade, submetidos a angioplastia percutânea transluminar, fazendo-se breve revisão da literatura. Dois pacientes permanecem assintomáticos 23 e 30 meses, respectivamente, após o tratamento. Houve recidiva da lesão em um dos pacientes, 12 meses após o procediemnto. Pela baixa morbidade e pelos bons resultados técnicos e clínicos a angioplastia percutânea transluminar deve ser o método de escolha para o tratamento da síndrome do roubo da subclávia.
Subject(s)
Middle Aged , Male , Female , Humans , Angioplasty, Balloon , Subclavian Steal Syndrome , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/therapy , Constriction, PathologicABSTRACT
Os autores apresentam o caso de um paciente submetido a cirurgia de revascularizaçäo miocárdica há 10 anos com anastomose da artéria mamária interna esquerda-artéria coronária descendente anterior e que há cerca de 2 meses voltou a apresentar dor precordial típica progressiva. Foi realizado estudo hemodinâmico que revelou anastomose mamária-coronária patente e lesäo obstrutiva severa da artéria subclávica esquerda, caracterizando-se assim a síndrome do roubo coronária-subclávia. O paciente foi entäo submetido a angioplastia transluminal percutânea da artéria subclávia esquerda com sucesso ocorrendo remissäo dos sintomas. Obteve-se o acompanhamento clínico do paciente, assintomático do ponto de vista cardiológico por 1 ano e 8 meses, quando entäo veio a falecer em decorrência de acidente vascular encefálico. Os autores recomendam atençäo especial as lesöes obstrutivas das artérias subclávias, com a realizaçäo de estudo angiográfico dos troncos supra-aórticos, especialmente naqueles pacientes com doença aterosclerótica difusa e/ou sinais de doença isquêmica cérebro-vascular e dos membros superiores, seja em pacientes que iräo submeter-se a cinecoronariografia e que potencialmente poderäo ter utilizadas as artérias mamárias para revascularizaçäo miocárdica, seja em pacientes submetidos a cirurgia de revascularizaçäo com o uso da artéria mamária e que voltam a apresentar angor e que no reestudo angiográfico mostram a anastomose patente