This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Angle, J. F. Articles by Tribble, C. G. Search for Related Content PubMed PubMed Citation Articles by Angle, J. F. Articles by Tribble, C. G. Pubmed/NCBI databases Medline Plus Health Information Angina Angioplasty Coronary Artery Bypass Surgery Social Bookmarking                         What's this?

Percutaneous Angioplasty and Stenting of Left Subclavian Artery Stenosis in Patients with Left Internal Mammary-Coronary Bypass Grafts: Clinical Experience and Long-Term Follow-up

Alan H. Matsumoto, MD

Division of Angiography, Department of Radiology, University of Virginia Health Sciences Center, Charlottesville, VA

J. Kevin McGraw, MD

Department of Radiology, Riverside Methodist Hospital, Columbus, OH

David J. Spinosa, MD

Klaus D. Hagspiel, MD

Daniel A. Leung, MD

Division of Angiography, Department of Radiology, University of Virginia Health Sciences Center, Charlottesville, VA

Curtis G. Tribble, MD

Department of Surgery, Division of Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, VA

The authors report their experience with percutaneous transluminal angioplasty (PTA) and stenting of the left subclavian artery (LSA) in patients with recurrent angina and a left internal mammary (LIMA)-coronary bypass graft or in patients who will be undergoing LIMA-coronary artery bypass grafting. From November 1990 to February 2001, 21 patients (1 1 men and 10 women) with significant left subclavian artery stenosis were treated; 18 patients had a prior LIMA bypass graft, and 3 patients were treated before coronary artery bypass surgery. Angiographic follow-up was performed in 12 patients and clinical follow-up was obtained in all patients. All lesions were atherosclerotic in etiology and located in the proximal left subclavian artery. The mean stenosis was 81% (range 50-100%). All patients initially underwent PTA. Stents were placed in 7 patients for suboptimal PTA results. Technical success was achieved in all patients. Pressure gradient measurements were available in 6 patients. Mean pretreatment gradient was 29 mm Hg (range, 10-50 mm Hg) and fell to 3 mm Hg (0-8 mm Hg) posttreatment. There were 2 minor and 2 major complications. The 30-day mortality rate was 9.5% (2 patients). The remaining 19 patients had clinical or angiographic follow-up of 4-68 months (mean, 27 months). Three patients were found to have recurrent stenoses by angiography 8-43 months after PTA and 3 more had clinical signs of recurrent stenosis. Therefore, the long-term clinical patency rate of LSA PTA and stent was 15 of 19 (79%). One was managed with bypass surgery, 1 with repeat PTA and stent placement, and 1 was managed conservatively. Therefore, the assisted patency was 15 of 19 (79%). Eleven of 19 (58%) of the patients in long-term follow-up had cardiac symptoms, but repeat angiography excluded recurrent LSA stenosis as the cause of their symptoms in 7 cases. Only 4/19 (2 1%) had cardiac symptoms potentially attributable to LSA restenosis. Four patients expired during follow-up, but 3 had no evidence of subclavian stenosis. PTA and stenting is an effective treatment of proximal left subclavian artery stenosis in patients who develop angina after a LIMA-coronary artery bypass, or in patients before a LIMA-CABG. Cardiac symptoms after LSA PTA and stent are most often due to progressive coronary artery disease rather than to recurrent LSA stenosis.

Vascular and Endovascular Surgery, Vol. 37, No. 2, 89-97 (2003)
DOI: 10.1177/153857440303700202


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				G. Rigatelli, P. Cardaioli, M. Giordan, S. Panin, S. Ferro, and L. Roncon New Subclavian Artery Angioplasty Technique for Treating Subclavian Coronary Steal Syndrome Ann. Thorac. Surg., August 1, 2007; 84(2): 688 - 689. [Abstract] [Full Text] [PDF]

				T. J. Takach, G. J. Reul, D. A. Cooley, J. M. Duncan, J. J. Livesay, D. A. Ott, and I. D. Gregoric Myocardial Thievery: The Coronary-Subclavian Steal Syndrome Ann. Thorac. Surg., January 1, 2006; 81(1): 386 - 392. [Abstract] [Full Text] [PDF]

				T. J. Takach, G. J. Reul, J. M. Duncan, Z. Krajcer, J. J. Livesay, I. D. Gregoric, R. D. Cervera, D. A. Ott, O. H. Frazier, and D. A. Cooley Concomitant Brachiocephalic and Coronary Artery Disease: Outcome and Decision Analysis Ann. Thorac. Surg., August 1, 2005; 80(2): 564 - 569. [Abstract] [Full Text] [PDF]