Fj. Criado et La. Queral, THE ROLE OF ANGIOPLASTY AND STENTING IN THE TREATMENT OF OCCLUSIVE LESIONS OF SUPRAAORTIC TRUNKS, Journal des maladies vasculaires, 21, 1996, pp. 132-138
Purpose To review the authors' four-year experience with endoluminal t
reatment of stenotic and occlusive lesions of supra-aortic trunks, and
to compare the results obtained with those achievable with more conve
ntional surgical reconstruction.Methods The authors' four-year experie
nce (7/1/91-6/30/95) with 30 endoluminal brachiocephalic procedures on
26 patients was reviewed retrospectively. The type of occlusive lesio
n encountered, arterial involvement, symptoms, and indications for tre
atment were noted. Patients were followed and reexamined at six-month
intervals and information from this assessment constituted the source
of information to determine success and patency rates. Only one patien
t was lost to follow-up at three months post intervention, at which ti
me the recanalized subclavian artery was patent and the patient was as
ymptomatic. Results There were no operative mortalities or strokes. On
e patient developed a large cervical wound hematoma which required sur
gical evacuation. Immediate (technical) success was achieved in 27 art
erial segments out of 30 which were approached with intention to treat
, for a success rate of 90 %. The three immediate failures involved to
tally occlusive lesions of the left proximal subclavian artery which p
roved unresponsive to retrograde transluminal recanalization. Long-ter
m arterial patency was achieved in 24 of 30 instances, for a success r
ate of 80 %. The three failures occurred respectively eight (right com
mon carotid artery), 12 (right subclavian artery), and 18 months (left
subclavian artery) after the initial procedure, and they all involved
restenosis following angioplasty/stenting. Conclusions The retrospect
ive review reported herein demonstrates that angioplasty/stenting of f
ocal stenotic and occlusive lesions of supra-aortic trunks would seem
to produce immediate and long-term success rates which are quite accep
table, and may approach those achievable with more conventional surgic
al reconstruction. Further reporting of larger series of patients Foll
owed up for longer periods of rime will be necessary for more definiti
ve conclusions regarding these less invasive therapeutic options.