Catheter‐based treatment of the subclavian and innominate arteries

Objectives : We report outcomes in patients undergoing catheter‐based intervention for symptomatic subclavian and innominate artery (S/IA) atherosclerosis. Background : Symptomatic S/IA obstructive lesions have traditionally been treated with open surgical revascularization. Catheter‐based endovascular therapies reduce the morbidity and mortality associated with surgery in many vascular beds. Methods : Between December 1993 and May 2006, 170 patients underwent primary stent placement in 177 S/IA arteries. Indications for revascularization included arm ischemia (57%), subclavian steal syndrome (37%), coronary‐subclavian steal syndrome (21%), and planned coronary bypass surgery with the involved internal mammary artery (8%). Results : Technical success was achieved in 98.3% (174/177) arteries, including 99.4% for stenotic lesions (155/156) and 90.5% for occlusions (19/21). There were no procedure‐related deaths and one stroke (0.6%, 1/170). Follow‐up was obtained in 151 (89%) patients at 35.2 ± 30.8 months, with a target vessel revascularization rate of 14.6% (23/157). At last follow‐up, 82% (124/151) of all treated patients remained asymptomatic with a primary patency of 83% and a secondary patency of 96%. Conclusions : Catheter‐based revascularization with stents for symptomatic S/IA lesions is safe and effective with excellent patency rates and sustained symptom resolution in the majority (>80%) of patients over 3 years of follow‐up. Percutaneous primary stent therapy is the preferred method of revascularization in patients with suitable anatomy. © 2008 Wiley‐Liss, Inc.