Percutaneous revascularization of atherosclerotic obstruction of aortic arch vessels

OBJECTIVES To compare stenting of aortic arch vessel obstruction with surgi cal therapy and to establish recommendations for treatment. BACKGROUND Though surgery has been considered to be the procedure of choice for subclavian and brachiocephalic obstruction, little work has been done to compare it with stenting. METHODS Eighteen patients with symptomatic aortic arch vessel stenosis or o cclusion were treated with stenting, followed by periodic clinical follow-u p and noninvasive arterial Doppler studies. Data were compared with the res ults as shown in a systematic review of a published series of surgery and s tenting procedures which included comparison of technical success, complica tions, mortality and patency. RESULTS Primary success in our series was 100% with improvement in mean ste nosis from 84 +/- 11% to 1 +/- 5% and mean arm systolic blood pressure diff erence from 14 +/- 16 mm Hg to 3 +/- 3 mm Hg. There were no major complicat ions (death, stroke, TIA, stent thrombosis or myocardial infarction). At fo llow-up (mean 17 months), all patients were asymptomatic with 100% primary patency. Literature review demonstrates equivalent patency and complication s in the other published series of stenting. In contrast, there was a simil ar patency but overall incidence of stroke of 3 +/- 4% and death of 2 +/- 2 % in the published surgical series. CONCLUSIONS Subclavian or brachiocephalic artery obstruction can be effecti vely treated by primary stenting or surgery. Comparison of stenting and the surgical experience demonstrates equal effectiveness but fewer complicatio ns and suggests that stenting should be considered as first line therapy fo r subclavian or brachiocephalic obstruction. (C) 1999 by the American Colle ge of Cardiology.