Wrotniak Leszek, Kabłak-Ziembicka Anna, Rosławiecka Agnieszka, Musiałek Piotr, Bogacki Paweł, Trystuła Mariusz, Żmudka Krzysztof, Przewłocki Tadeusz
Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
J Vasc Surg. 2016 Sep;64(3):684-91. doi: 10.1016/j.jvs.2016.04.031.
A minor part of patients with subclavian or innominate artery occlusive disease (subclavian artery stenosis [SAS]) experience symptoms of vertebrobasilar insufficiency, upper extremity exertional ischemia (UEEI), or cardiac ischemia owing to subclavian-coronary steal (SCS) in some instances. The study aimed to assess the impact of percutaneous transluminal angioplasty (PTA) of symptomatic SAS on symptom resolution and to determine factors related with SAS recurrence.
Symptom resolution and incidence of restenosis (RS) were evaluated for up to 15 years in patients who had undergone successful PTA of SAS.
The study group comprised 232 consecutive subjects after successful PTA of SAS (61.9 ± 8.4 years old 53.4% men). The mean follow-up time was 101 ± 40 months (range, 5-188 months). One month after PTA, 85.4% of the study participants were free from dizziness, 94.4% from imbalance, 97.1% from visual disturbances, 97.8% from syncope, 98.7% from UEEI, and 100% from SCS. RS was found in 37 patients (15.9%) in long-term observation. UEEI, dizziness, imbalance, and SCS were significantly more frequent in patients with SAS recurrence, as compared with patients with patent artery (65.9% vs 3.1% [P < .001] 63.4% vs 19.4% [P < .001]; 26.8% vs 9.4% [P = .005]; and 100% vs 15.4% [P = .018], respectively). Smaller stent diameter (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.79-0.96; P = .004), implantation of ≥2 stents for a lesion (OR, 1.15; 95% CI, 1.05-1.26; P = .003), concomitant stenosis in the carotid or vertebral artery (OR, 1.10; 95% CI, 1.01-1.21; P = .036), high-sensitivity C-reactive protein level (OR, 1.20; 95% CI, 1.09-1.31; P < .001), and high-density lipoprotein level (OR, 0.91; 95% CI, 0.82-0.98; P = .021) were associated independently with risk of RS, whereas recurrence of UEEI (relative risk, 1.71; 95% CI, 1.55-1.90; P < .001), dizziness (OR, 1.26; 95% CI, 1.14-1.39; P < .001), limb paresthesia (OR, 1.14; 95% CI, 1.04-1.25; P = .005), and angina in subjects after coronary artery bypass grafting (OR, 1.11; 95% CI, 1.01-1.21; P = .024) were associated with RS/SAS progression after PTA.
Angioplasty of SAS leads to symptom resolution in most patients. UEEI, dizziness, and angina recurrence are predictors of RS or SAS progression; high-sensitivity C-reactive protein, smaller stent diameter, and number of implanted stents predict RS.
锁骨下动脉或无名动脉闭塞性疾病（锁骨下动脉狭窄[SAS]）患者中有一小部分在某些情况下会出现椎基底动脉供血不足、上肢运动性缺血（UEEI）或由于锁骨下-冠状动脉窃血（SCS）导致的心脏缺血症状。本研究旨在评估有症状SAS的经皮腔内血管成形术（PTA）对症状缓解的影响，并确定与SAS复发相关的因素。
对成功接受SAS PTA的患者进行长达15年的症状缓解情况和再狭窄（RS）发生率评估。
研究组包括232例成功接受SAS PTA的连续受试者（年龄61.9±8.4岁，男性占53.4%）。平均随访时间为101±40个月（范围5-188个月）。PTA后1个月，85.4%的研究参与者无头晕，94.4%无失衡，97.1%无视觉障碍，97.8%无晕厥，98.7%无UEEI，100%无SCS。长期观察发现37例患者（15.9%）出现RS。与动脉通畅的患者相比，SAS复发患者的UEEI、头晕、失衡和SCS明显更频繁（分别为65.9%对3.1%[P<.001]；63.4%对19.4%[P<.001]；26.8%对9.4%[P=.005]；100%对15.4%[P=.018]）。较小的支架直径（优势比[OR]，0.87；95%置信区间[CI]，0.79-0.96；P=.004）、病变植入≥2个支架（OR，1.15；95%CI，1.05-1.26；P=.003）、颈动脉或椎动脉合并狭窄（OR，1.10；95%CI，1.01-1.21；P=.036）、高敏C反应蛋白水平（OR，1.20；95%CI，1.09-1.31；P<.001）和高密度脂蛋白水平（OR，0.91；95%CI，0.82-0.98；P=.021）与RS风险独立相关，而UEEI复发（相对风险，1.71；95%CI，1.55-1.90；P<.001）、头晕（OR，1.26；95%CI，1.14-1.39；P<.001）、肢体感觉异常（OR，1.14；95%CI，1.04-1.25；P=.005）和冠状动脉旁路移植术后患者的心绞痛（OR，1.11；95%CI，1.01-1.21；P=.024）与PTA后RS/SAS进展相关。
SAS血管成形术可使大多数患者症状缓解。UEEI、头晕和心绞痛复发是RS或SAS进展的预测因素；高敏C反应蛋白、较小的支架直径和植入支架数量可预测RS。
