Rates of symptom reoccurrence after endovascular therapy in subclavian artery stenosis and prevalence of subclavian artery stenosis prior to coronary artery bypass grafting.

ABSTRACT

Percutaneous transluminal angioplasty (PTA) and stenting is commonly used to treat subclavian artery stenosis (SAS). In this study, the outcomes of 43 consecutive cases, performed at one institution from October 1997 to October 2005, were analyzed. Mean stenosis was 84.41% pre-intervention and 6.83% post-intervention. Five of the procedures were angioplasty alone; 38 were angioplasty with stenting. Technical success was achieved in 42 out of 43 patients. The 30-day mortality rate was 0%. At one-month post intervention, all patients were symptom free. Ten patients redeveloped symptoms by one year. Demographic data, patient comorbidities, and indication to treat were analyzed. It was found that prior coronary intervention led to a statistically significant higher rate of symptom reoccurrence (p = 0.036). Additionally, a divergence in the rate of symptom reoccurrence based on indication to treat SAS was noted with the highest rate of symptom reoccurrence in the pre-coronary artery bypass grafting (CABG) group and the lowest rate of symptom reoccurrence in the subclavian steal syndrome (SSS) group. The coronary subclavian steal (CSS) group had an intermediate rate of symptom reoccurrence. During this time period, 1154 CABGs were performed. Flow-limiting stenosis was noted on angiography in 17 of these patients, giving pre-CABG prevalence of 1.46%.