THE ROLE OF ANGIOPLASTY AND STENTING IN THE TREATMENT OF OCCLUSIVE LESIONS OF SUPRAAORTIC TRUNKS

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.