Therapeutic strategy and outcome of stenting for subclavian and innominate artery occlusive disease

We performed stenting for the subclavian artery (SA) and innominate artery occlusive disease in 14 patients between April, 2000 and March, 2003. In 13 of 14 patients, good dilatation was obtained with stenting. In one patient with left SA occlusion, true lumen could not be detained from either proximal or distal sides of the occluded lesion, so stent deployment was not performed. From June, 2002, we performed stenting using combined femoral and brachial approaches in 6 of 8 patients. In patients in whom occlusive lesion existed in the proximal portion of the SA, it was useful strategy to create a "pull-through" system to stabilize the guiding catheter position in the aorta or the proximal portion of the SA, and to protect the vertebral artery (VA) with a balloon catheter. Post-operative morbidity was 0%. Restenosis was manifested in one patient (8%) two years after stent placement, and in-stent PTA was carried out. In stenting for the subclavian and innominate arteries, the pull-through system is considered useful for stabilization of the guiding catheter, and protection of the VA for prevention of distal embolism to the VA.