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

Abstract

BackgroundSubclavian artery stenosis (SAS) is narrowing of the subclavian artery most commonly caused by atherosclerosis. It serves as a marker for cerebrovascular and myocardial ischemic events.MethodsA retrospective cohort study was conducted to determine the association of treatment via combination therapy (antiplatelet drug plus either by-pass surgery or percutaneous transluminal angioplasty (PTA) with or without stent implantation) versus antiplatelet drug therapy alone on cardiovascular events and all-cause mortality in Marshfield Clinic patients diagnosed with symptomatic SAS from January 1, 1995 to December 31, 2009.ResultsOf the total 2153 cases, 100 patients were identified as eligible to be included in the study. Of these 100 patients that met inclusion criteria, 30 underwent combination therapy while 70 were managed only with drug treatment. A median length of follow-up was 8.45 years. Adverse cardiovascular events occurred in 5/30 (17%) of combination therapy patients compared to 28/70 (40%) of antiplatelet drug therapy only patients (p = 0.0355). Accordingly, all-cause mortality was higher (47%) in the antiplatelet drug therapy only group than the combination therapy group (13%) [hazard ratio = 3.45, p = 0.0218].ConclusionsPreliminary findings in this pilot data set suggest that combination therapy (medications plus either surgical or interventional repair) of subclavian artery stenosis is associated with less cardiovascular adverse events and higher survival rates. However, prospective randomized studies with larger number of patients are needed to validate these findings.

Critical Left Subclavian Artery Stenosis With Retrograde Vertebral Flow: A Case Report and Literature Review

“…Left-sided subclavian artery stenosis is more common than right-sided SAS, with a reported prevalence of 70-80% of all cases of SAS [ 5 ]. Most patients will remain asymptomatic [ 6 ] due to incomplete stenosis or revascularization by retrograde flow through the vertebral artery.…”

“…In these patients, glycemic control is necessary with the target HbA1c of less than 7% [ 3 ], high-intensity statin therapy to reduce low-density lipoprotein (LDL) cholesterol, as well as an angiotensin-converting enzyme (ACE) inhibitors for blood pressure reduction if needed [ 1 ]. Additionally, current recommendations include the initiation of antiplatelet therapy for patients with SAS [ 5 ].…”

“…Current SAS management guidelines highly advocate for dual antiplatelet therapy (DAPT) after subclavian stenting, using aspirin and clopidogrel [ 3 , 5 ]. However, no randomized control trials have been performed to investigate single-agent versus dual-agent antiplatelet regimens [ 3 ].…”

Farmácia Colorida: Tecnologias De Saúde Para a População Indígena

“…( ARAUJO et al, 2017and EPPERLA et al, 2017and ARBOINE et al, 2017 Além disso, os pacientes podem relatar sintomas neurológicos compatíveis com hipoperfusão vertebrobasilar, devido ao desvio competitivo do fluxo sanguíneo para a artéria subclávia através de um círculo de patentes de Willis. (WADUUD et al, 2018) A prevalência da SRS é desconhecida, porém estimada entre 0,6% a 80%, já que a maioria dos pacientes com esta síndrome são assintomáticos.…”

Relação Entre Queixa Proctológica E Diagnóstico De Pacientes Referenciados a Um Ambulatório Universitário

“…( DE FREITAS et al, 2016;CUA et al, 2017; ARAUJO et al, 2017 andARBOINE et al ,2017) Contudo, outras condições podem prejudicar o fluxo para esse vaso como as arterites de Takayasu e de células gigantes e o desenvolvimento de fluxo competitivo por uma fístula de hemodiálise que nesse caso apareceria na ausência de estenose da artéria. ( ARAUJO et al, 2017and EPPERLA et al, 2017and ARBOINE et al, 2017 Além disso, os pacientes podem relatar sintomas neurológicos compatíveis com hipoperfusão vertebrobasilar, devido ao desvio competitivo do fluxo sanguíneo para a artéria subclávia através de um círculo de patentes de Willis (WADUUD et al, 2018). A prevalência da SRS é desconhecida, porém estimada entre 0,6% a 80%, já que a maioria dos pacientes com esta síndrome são assintomáticos.…”