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Title:
Prognostic factors and long term results after subclavian artery percutaneous angioplasty
Author:
Subject:
results of treatment ; restenosis ; subclavian artery percutaneous angioplasty ; symptoms
Abstract:
The prognosis of the subclavian or innominate artery (SA/IA) stenosis and results of SA/IA percutaneous angioplasty (PT A) remain poorly investigated. The study aimed to evaluate the safety, success rate and symptoms resolution rate after a PT A of SA/IA, as well as long-term outcomes after the procedure, with a focus on predictors of restenosis (RS) and adverse cardiovascular events (MACCE). The analysis included 411 consecutive patients who had undergone PTA of SA/IA. The procedure was successful in 96%. Serious complications occurred in 1,2% procedures. Coronary artery disease was present in ⩾ 50% and carotid stenosis in 40% of patients. Resolution or a clinically meaningful reduction of symptoms was achieved in 98% of patients after a successful PT A. RS occured in 14, 7% of patients after a mean 5 years of follow-up. RS can be reliably diagnosed combining clinical evaluation and DUS. Risk ofRS increased with implantation of ⩾2 stents for a lesion, implantation of too small stents, after PT A of the IA, with coexisting carotid or vertebral stenosis, in patients with increased inflammatory markers and when disease developed in younger age. As restenosis may occur many years after the intervention, prolonged follow-up is mandated. Cardiovascular risk was related to inflammatory status and coexisting coronary and cerebrovascular atherosclerosis. For this reason routine asses ; sment of other major arteries is advisable in this population. An easily accessible predictor of MACCEE in patients after SA/IA endovascular revascularization, was CIMT progression.