| Abstract: | Recently percutaneous transluminal angioplasty (PTA) has been used to treat atherosclerotic lesion of the brachiocephalic arteries. We treated two patients with subclavian steal syndrome successfully by PTA. The first patient was a 52-year-old man complaining of vertigo and ischemic symptoms of the left arm. Blood pressure was 110/90 mmHg in the left arm and 140/92 mmHg in the right. On the angiogram, about 80% stenosis was found in the proximal portion of the left subclavian artery, and retrograde filling of the left vertebral artery was observed. At first, a carotid-subclavian bypass surgery was performed, but unfortunately failed because of obstruction of the artificial arterial graft. Then we performed PTA using Grüntzig balloon dilatation catheter. The dilatation was carried out successfully. Immediately after PTA, to-and-fro and antegrade flow of the vertebral artery was observed, and one month later it became normal flow. Neurological symptoms gradually disappeared within two months. The second patient was a 57-year-old man suffering from vertigo on effort and TIA. Blood pressure was 130/78 mmHg in the left arm, and 152/82 mmHg in the right. Angiogram showed more than 95% stenosis of the left subclavian artery, and retrograde filling of the left vertebral artery. We also observed bilateral severe stenosis of the MCA. Carotid-subclavian bypass was dangerous because of the low perfusion of the ipsilateral MCA area. PTA was performed as the first choice, and the dilatation of the stenosis was sufficient. In two months natural antegrade filling of the left vertebral artery was obtained. We followed these patients for 12 months and no restenosis was observed neurologically and radiologically. We performed PTA with the Grüntzig balloon catheter using the Seldinger's method through the right femoral artery. Diameter of the balloon was 6 mm and its length was 4 cm. After setting the balloon to the stenotic lesion, we inflated the balloon with 5atm (75 psi) pressure for 30 minutes. Monitoring the blood pressure and arterial pressure wave at the tip of the catheter, we repeated inflation of the balloon 4 times. We used continuous venous infusion of low molecular dextran and heparin during PTA procedures. No complication occurred and neurological symptoms disappeared gradually. PTA is a safe and effective method, so it should be the first choice in the treatment of subclavian steal syndrome caused by severe stenosis of the subclavian artery. |
