PRIMARY STENT DEPLOYMENT IN OCCLUSIVE SUBCLAVIAN ARTERY DISEASE

Primary (without antecedent balloon dilation) Palmaz(TM) stent implant ation was successfully performed in 27 consecutive patients entering w ith 31 obstructed subclavian arteries. Stents (n=50) were successfully deployed, using the brachial (n=7), femoral (n=16), or combined (n=8) approach, to revascularize 31 subclavian vessels [8 occluded (26%); 2 3 stenotic (74%)], using a 6 or 7.5 French delivery system. The indica tions for intervention were arm claudication in 8 patients (30%), subc lavian steal syndrome in 11 patients (41%), angina pectoris secondary to impaired blood flow to the left internal mammary artery coronary by pass in 6 patients (22%), and recanalization of a left subclavian occl usion to permit central arterial access and performance of a second in terventional procedure 2 patients (7%). The percent diameter stenosis improved from 85 +/- 12% to 6 +/- 7% (P<0.001)); and, the peak and mea n translesion gradients decreased, respectively, from 56 +/- 35 mm Hg to 3 +/- 4 mm Hg (P<0.01), and 29 a 18 mm Hg to 2 a 2 mm Hg (P<0.01). Procedural complications encountered were one stent dislodgement with migration into and uneventful deployment within the right external ili ac artery, and two brachial artery repairs. No acute vessel closures, deaths, myocardial infarctions, cerebrovascular accidents, transient i schemic attacks, or need for transfusions occurred. Therefore, primary subclavian artery stent deployment can be performed using low-profile sheath systems with excellent success (100%), resulting in immediate restoration of pulsatile flow, and few complications. The incidence of lesion recurrence remains for follow-up studies. (C) 1995 Wiley-Liss, Inc.