Percutaneous transluminal angioplasty of the subclavian arteries

Purpose: To review the feasibility, risks, and long-term results of subclav ian artery angioplasty with and without Palmaz stent placement. Methods: Over a g-year period, 113 patients (67 males; mean age 63 +/- 13 y ears) underwent percutaneous balloon angioplasty of subclavian occlusive le sions for a variety of indications: vertebrobasilar insufficiency (n = 70), upper limb ischemia (n = 50), coronary steal syndrome (n = 6), or anticipa ted coronary artery bypass grafting using the internal mammary artery in 12 asymptomatic patients. There were 94 (83%) stenoses and 19 (17%) occlusion s with a mean percent stenosis of 80.1% +/- 7.4% (range 70 to 100). Mean le sion length was 24 +/- 8 mm (range 10 to 50). Beginning in 1989, stents wer e implanted for suboptimal dilation; in 1995, stenting became routine. Results: Overall, 103 (91%) of 113 lesions were successfully treated; 10 (5 3%) occlusions could not be recanalized. Fifty-one stents were implanted in 46 patients. There were 3 (2.6%) procedural complications: a transient isc hemic attack, one major (fatal) stroke, and an arterial thrombosis 24 hours after the procedure (treated medically) (0.9% major stroke and death rate) . During a mean 4.3-year follow-up (range to 10), 16 (15.5%) restenoses were treated with angioplasty (n = 4), stenting (n = 7), or surgery (n = 5). Pri mary and secondary patencies for all treated lesions (n = 113) at 8 years w ere 75% and 81%, respectively; in patients without initial stent placement, the rates were 69% and 76%, while in those with stents, the rates rose sli ghtly to 87% and 94% at 2.5 years (NS). Patency rates for all 103 recanaliz ed lesions were 83% and 90% at 8 years (81% and 90% without stent and 87% a nd 94% with stent at 2.5 years, respectively [NS]). Conclusions: Balloon angioplasty with or without stenting is safe and effec tive for treating subclavian artery occlusive diseases with good long-term patency. Recanalization of occlusions is more difficult to achieve. Stents (implanted only for suboptimal dilation) do not seem to improve long-term p atency.