[Percutaneous transluminal angioplasty (PTA) for stenosis at the subclavian artery and at the origin of the vertebral artery: therapeutic indication and some adjunctive safe methods during PTA].

Percutaneous transluminal angioplasty (PTA) for brachiocephalic occlusive lesions has progressed. In this paper our experiences and results of PTA in dealing with those lesions are described with emphasis on adjunctive procedures during PTA. Recently, twenty-four patients with stenosis of the subclavian artery (SA) and/or stenosis at the origin of the vertebral artery (VA) were included in this study. Among the 24, there were 16 cases with SA stenosis, 6 cases with stenosis at the origin of VA and 3 cases with both SA and stenosis at the origin of VA. The stenosis was due to atherosclerosis in 21 cases and aortitis in 3 cases. Most of the patients presented ischemic symptoms of vertebrobasilar circulation and affected upper extremities. In PTA of brachiocephalic lesions, one of the most formidable complications is an embolism distal to the central nervous system. To prevent this complication, a vascular endoscope was used for visualization of the luminal surface of the stenotic lesions in 7 cases, and a protective balloon was used in 4 recent cases. The protective balloon was used for transient occlusion of the artery to alter the flow direction so that the possible emboli might be forced to flow away to a less critical distal artery. In the distal protective balloon technique, the protective balloon was set so as to occlude the stenotic artery distally. Debris caused by PTA was aspirated and/or washed out to an extracranial artery with heparinized saline. In the proximal protective balloon technique, the protective balloon was set so as to occlude the stenotic artery proximally. Debris was washed out with blood flow caused by the induced steal phenomenon to an extracranial artery.(ABSTRACT TRUNCATED AT 250 WORDS)