Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization

English, JoAnna L.; Carell, Edgar S.; Guidera, Steven A.; Tripp, Henry F.

doi:10.1002/ccd.1230

Cited by 135 publications

(112 citation statements)

References 15 publications

(18 reference statements)

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“…73 IAD prevalence is also high (78-88%) in subclavian steal syndrome, 74,75 and the severity of the stenosis has been associated with the size of the BP difference. 76 In another large series of patients presenting for coronary angiography, the non-simultaneously measured IAD had a low sensitivity and positive predictive value, but high specificity (85% for 410 mm Hg and 94% for X20 mm Hg) and negative predictive value (99% for 410 mm Hg and 98% for X20 mm Hg) for predicting subclavian stenosis, 77 and aortic arch angiography in a series of subjects with PVD showed a measurable stenosis of at least one brachiocephalic artery in 42% of 48 subjects studied. 78 Thus, there is evidence of an association of the IAD with symptomatic PVD.…”

Section: Pathophysiology Of the Iadmentioning

confidence: 99%

Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

et al. 2006

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A blood pressure (BP) difference between arms was first reported over 100 years ago. Knowledge of its prevalence and relevance to the accurate measurement of BP remains poor. Current hypertension guidelines do not emphasise it. The objectives of this study were to establish the best estimate of prevalence of the interarm difference (IAD) in the population, to consider its implications for accurate BP measurement and treatment, and to discuss its aetiology and potential as a risk marker for cardiovascular disease. Systematic literature review was carried out. The data sources were Medline EMBASE and CINAHL databases, and Index of Theses. Studies reporting prevalence rates of IAD were retrieved and considered for inclusion against explicit methodological criteria. Point prevalence rates were extracted and weighted mean prevalence rates calculated. The main outcome measures were weighted mean prevalences of systolic IADX10 and X20 mm Hg and of diastolic IADX10 mm Hg. Thirty-one studies were identified. Most had methodological weaknesses; only four met the inclusion criteria. Pooled prevalences of the IAD from these four studies were 19.6% systolic X10 mm Hg (95% CI 18.0-21.3%), 4.2% systolic X20 mm Hg (95% CI 3.4-5.1%) and 8.1% diastolic X10 mm Hg (95%CI 6.9-9.2%). In conclusion, an IAD is present in a substantial number of patients and should be looked for whenever diagnosis and treatment depend on accurate measurements of BP. The importance of an IAD should be better emphasised in current hypertension management guidelines. There is evidence associating an IAD with peripheral vascular disease, raising the possibility that its presence may predict cardiovascular events. IntroductionPatients are regularly encountered in the clinical setting with a different systolic or diastolic blood pressure (BP) in each arm. Comparisons of arm pressures have been made ever since the modern sphygmomanometer was introduced, 1 yet the significance of this finding, which Cyriax named the 'differential BP sign', 2 is still poorly appreciated today.Hypertension is one of the major causes of premature morbidity and mortality throughout the developed and developing worlds. 3 The vast majority of patients with hypertension are managed in primary care 4 and measurement of BP is the most common investigation performed in this setting. 5 The management of hypertension is known to be suboptimal; 6 therefore, knowledge of the latest guidelines, and the many factors known to influence readings, is crucial. 7 The prevalence of a systolic (sIAD) or a diastolic (dIAD) inter-arm difference, its importance for the management of hypertension, its significance as a potential marker of peripheral vascular disease (PVD) and predictor of cardiovascular disease (CVD) in hypertensive patients are the subjects of this review.Although recent ambulatory BP monitoring guidelines recommend routine bilateral assessment, 8 the latest British guidelines for the management of hypertension merely state that 'BP should initially be measured in both arms as patient...

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Section: Pathophysiology Of the Iadmentioning

confidence: 99%

Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

et al. 2006

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“…Data were separately analysed according to previously described cut off values for SBP differences of  10 and < 15 mmHg,  15 and < 20 mmHg or  20 mmHg. 9,10,11 An difference in SBP of <10 mmHg was considered an equal BP in both arms.…”

Section: Blood Pressure Measurementsmentioning

confidence: 99%

Upper Extremity Blood Pressure Difference in Patients Undergoing Carotid Revascularisation

Huibers

Hendrikse

Brown

et al. 2017

European Journal of Vascular and Endovascular Surgery

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What this paper addsThis study reports that one out of every five patients with carotid stenosis amenable to surgery exhibit inter-arm SBP difference >15 mmHg and approximately one fifth of those with inter-arm SBP difference suffer from subclavian or innominate artery stenosis. Our results therefore affirm the clinical need for inter-arm BP differences in patients undergoing carotid revascularization, especially in the postoperative phase in the prevention of cerebral hyperperfusion.Abstract:

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“…Atherosclerosis is the most common cause of this condition, but other etiologies include arteritis, inflammation due to radiation exposure, compression syndromes, fibromuscular dysplasia, and neurofibromatosis. The incidence of subclavian stenosis in the general population ranges from 3% to 4%, 1 and can be as high as 11-18% in patients with documented peripheral artery disease. 2 Of those patients found to have subclavian or innominate lesions, 50% have concomitant coronary artery disease, 27% lower extremity artery involvement and 29% carotid obstructive disease.…”

Section: Introductionmentioning

confidence: 99%

Subclavian artery stenosis: A review for the vascular medicine practitioner

2010

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Peripheral artery disease assessment typically focuses on the evaluation of lower extremity symptoms and physical findings. Few practitioners consider the importance of upper extremity arterial disease; which, besides causing hand and arm symptoms, can be associated with significant neurologic and cardiac sequelae. A review of the existing literature through PubMed using the search term 'subclavian stenosis' was performed. The latest original articles, including clinical studies, case reports and limited reviews of this topic were adapted. A comprehensive article review focusing on the diagnostic and treatment approach for subclavian stenosis was prepared. In conclusion, vascular medicine practitioners including cardiologists and vascular surgeons caring for patients with arterial disease should routinely assess for subclavian stenosis. There are excellent screening tools and effective medical therapies which can be instituted if diagnosed early. When the need for revascularization arises, percutaneous modalities are favored given their proven long-term efficacy, decreased morbidity and mortality, and cost-effectiveness.

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Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization

Cited by 135 publications

References 15 publications

Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

Upper Extremity Blood Pressure Difference in Patients Undergoing Carotid Revascularisation

Subclavian artery stenosis: A review for the vascular medicine practitioner

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