Angioplasty and primary stenting of the subclavian, innominate, and commoncarotid arteries in 83 patients

Purpose: The initial and long-term results of angioplasty and primary stent ing for the treatment of occlusive lesions involving the supra-aortic trunk s were studied. Methods: All patients in whom angioplasty and stenting of the supra-aortic trunks was attempted were included in a prospective registry. Results are, therefore, reported on an intent-to-treat basis. The preprocedural and post procedural clinical records, arteriograms, and noninvasive vascular laborat ory examinations of 83 patients (41 men [49.4%] and 42 women [50.6%]; mean age at intervention, 63 years) in whom endovascular repair of the subclavia n (66, 75.9%), left common carotid (14, 16.1%), and innominate (7, 8.0%) ar teries was attempted were retrospectively reviewed. Results: Initial technical success was achieved in 82 of 87 procedures (94. 3%). The inability to cross 4 complete subclavian occlusions and the iatrog enic dissection of 1 common carotid artery lesion accounted for the 5 initi al failures. Complications occurred in 17.8% of 73 subclavian and innominat e procedures, including access-site bleeding in 6 and distal embolization i n 2. Ischemic strokes occurred in 2 of 14 common carotid interventions (14. 3%), both of which were performed in conjunction with ipsilateral carotid b ifurcation endarterectomy. The 30-day mortality rate was 4.8% for the entir e group. By means of Life-table analysis, 84% of the subclavian and innomin ate interventions, including initial failures, remain patent by objective m eans at 35 months. No patients have required reintervention or surgical con version for recurrence of symptoms. Of the 11 patients available for follow -up study who underwent common carotid interventions, 10 remain stroke-free at a mean of 14.3 months. Conclusion: Angioplasty and primary stenting of the subclavian and innomina te arteries can be performed with relative safety and expectations of satis factory midterm success. Endovascular repair of common carotid artery lesio ns can be performed with a high degree of technical success, but should be approached with caution when performed in conjunction with ipsilateral bifu rcation endarterectomy.