Anatomic and clinical predictors of reintervention after subclavian artery stenting

Abstract

SAS has a high primary success and durability with satisfactory outcomes well beyond 10 years. ISR was more likely to develop in patients who were smokers with chronic obstructive disease or had a baseline vessel size of ≤7 mm. Younger age could be an independent risk factor for secondary intervention.

Subclavian Steal Syndrome with or without Arterial Stenosis: A Review

“…Multivariate analysis found that smoking, chronic obstructive pul-monary disease, and subclavian artery diameter less than 7 mm were predictors of restenosis, whereas age and statin treatment displayed a protective effect. 44 A similar prospective study of 110 patients treated with percutaneous transluminal angioplasty reported 93% procedural success. Again, most patients were treated for posterior circulation deficiency (37%), whereas 20 patients underwent preventive angioplasty of the subclavian artery before coronary artery bypass surgery with internal mammary artery graft.…”

“…Stent restenosis occurred in 25 out of 134 arteries available for follow‐up. Multivariate analysis found that smoking, chronic obstructive pulmonary disease, and subclavian artery diameter less than 7 mm were predictors of restenosis, whereas age and statin treatment displayed a protective effect …”

Resolution of ischemic symptoms after percutaneous angioplasty for a symptomatic subclavian artery stenosis

“…28 In another study conducted on 138 patients who underwent PTA for a symptomatic SAS, the researchers reported primary patency rate of 91%, 77%, and 68% at 1, 5, and 10 years, respectively. 29 RS-free survival reported by van de Weijer et al 26 was 95.6%, 92.9%, 87.6%, and 83.2% at 12, 24, 48, and 60 months, respectively. 26 An analysis of the incidence of symptom recurrence in relation to the RS or SAS progression rate in the present study revealed a very important findingdthe recurrence of UEEI, limb paresthesia, dizziness, and, in patients after CABG with IMA implantation, also of angina pectoris is independently associated with RS and/or SAS progression.…”

“…The SCALLOP registry researchers evidenced that critical hand ischemia (hazard ratio [HR], 4.6; 95% CI, 2.06-10.2; P < .001), along with cerebrovascular disease (HR, 1.9; 95% CI, 1.14-3.06; P ¼ .01), current smoking (HR, 1.8, 95% 1.14-2.79; P ¼ .01), and lesion length (in 1-cm increments; HR, 1.02; 95% CI, 1.00-1.04; P ¼ .03) were negative independent predictors of primary patency, in contrast with intravascular ultrasonography use (HR, 0.6; 95% CI, 0.30-0.96; P ¼ .04), which was a positive predictor of primary patency. 28 Mousa et al 29 showed the following significant predictors of RS: smoking/chronic obstructive pulmonary disease (HR, 3.2; P ¼ .001), vessel diameter 7 mm or less (HR, 2.3; P ¼ .028), age by decade (HR, 0.5; P < .001), discharge with statin therapy (HR, 0.3; P ¼ .001), and right-sided intervention (HR, 0.3; P ¼ .040). This study did not address symptom recurrence.…”

Treatment-Related Cardiovascular Outcomes in Patients with Symptomatic Subclavian Artery Stenosis

“…The majority of studies evaluating surgical procedures or PTA in patients with SAS have shown favorable vessel patency rates extending beyond 10 years [24, 27-28]. PTA with or without stenting is currently considered the treatment of choice for patients with SAS [18], but whether stenting alters procedural efficacy is currently unknown [19].…”