Successful percutaneous revascularization of totally occluded left subclavian artery using orbital atherectomy |
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| Authors: | Nuri Ilker Akkus Faisal Bahadur Mehmet Cilingiroglu |
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| Affiliation: | 1. LSU Health Sciences Center Shreveport, Division of Cardiovascular Diseases Shreveport, LA;2. University of Pittsburgh Medical Center, Division of Cardiovascular Diseases Pittsburgh, PA;1. Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan;2. Department of Clinical and Laboratory Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan;1. Division of Vascular and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX;2. Department of Medicine, Baylor College of Medicine, Houston, TX;1. Unit of Vascular and Endovascular Surgery, Department of Surgery “Paride Stefanini”, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy;2. Unit of Vascular and Interventional Radiology, Department of Radiology, Oncology, and Anatomic Pathology, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy;1. Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan;2. Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan |
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| Abstract: | Subclavian artery steal (SAS) after coronary artery bypass graft (CABG) has been reported to be as high as 3.4%. These patients with patent left internal mammary artery (LIMA) anastomosis will also have coronary–subclavian steal syndrome (CSSS). Percutaneous intervention (PCI) by balloon angioplasty (BA) and stenting has been done successfully for subclavian artery (SA) stenosis. The visibility of the vertebral artery (VA) and LIMA during BA and stent positioning is extremely important. Debulking total occlusions by orbital atherectomy (OA) and avoiding unnecessary BA, stenting across side branches may decrease the chance of plaque shifting and subsequent loss of flow especially if they have ostial disease. Herein we report successful OA, BA and stenting of chronic total occlusion (CTO) of proximal left subclavian artery in a patient with coronary–subclavian steal syndrome with preservation of LIMA and diseased left vertebral artery (VA). |
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