Long term outcome after balloon angioplasty and stenting of subclavian artery obstruction: a single centre experience.

INTRODUCTION: Percutaneous transluminal angioplasty is an accepted and successful treatment strategy in obstructive disease of the subclavian artery. The purpose of this study was to evaluate the technical and clinical long-term outcome following endovascular therapy. PATIENTS AND METHODS: We retrospectively analyzed 99 patients (mean age of 65 +/- 10 years) with 100 interventions of the subclavian arteries and the brachiocephalic trunk with different aetiologies [atherosclerosis (90%); Takayasu's arteritis (5%); thromboembolism (2%); external compression (1%); iatrogenic dissection (1%) and occlusion after graft implantation in type B dissection (1%)]. RESULTS: Primary success rate was 97% (100% for stenoses and 90% for total occlusions). Treatment modalities included balloon angioplasty (PTA) alone (16%), stent implantation (78%), rotational thrombectomy (2%) and atherectomy (1%). The primary 1-year patency rate of the whole study cohort was 87% being not significantly lower after PTA (75%) compared to stent assisted angioplasty (89%). After thrombectomy and atherectomy no relevant restenosis were found. Multivariable analysis of 1-year restenosis-free survival revealed younger age (p = 0.03) and stenting (p = 0.04) as independent predictor. The blood pressure difference between both limbs at baseline was 42 +/- 24 mmHg and dropped to 10 +/- 14 mmHg after the intervention and 15 +/- 20 mmHg after 12 months, respectively (p = 0.01). CONCLUSIONS: Endovascular therapy of subclavian artery obstructions of various aetiologies offers good acute success rates even in total occlusions. Long-term patency rate is in favour of stent placement.

Dose-ranging studies of anisoylated plasminogen streptokinase activator complex. Studies in healthy volunteers and in patients with acute myocardial infarction.

Anisoylated plasminogen streptokinase activator complex (APSAC) is well tolerated when given as an intravenous bolus dose over 2 to 4 minutes. The intravenous administration of 30U was rapidly effective in patients with coronary artery occlusion, with 82% of successfully treated patients responding to the initial APSAC dose after a mean time of about 30 minutes. The plasma fibrinogen and plasminogen concentrations decreased in all patients receiving APSAC 30U, which indicates that APSAC at this dose is not sufficiently fibrin-specific to dissolve thrombi without producing a lytic state. Side effects, complications and mortality were as expected for thrombolytic agents, with only 1 bleeding episode other than at the catheterisation site. Thus, APSAC offers unique advantages of rapid and simple bolus intravenous administration, with reperfusion rates achieved that are similar to those expected for intracoronary streptokinase and for intravenous tissue plasminogen activator.