The role of angioplasty and stenting in the treatment of occlusive lesions of supra-aortic trunks.

PURPOSE

To review the authors' four-year experience with endoluminal treatment of stenotic and occlusive lesions of supra-aortic trunks, and to compare the results obtained with those achievable with more conventional surgical reconstruction.

METHODS

The authors' four-year experience (7/1/91-6/30/95) with 30 endoluminal brachiocephalic procedures on 26 patients was reviewed retrospectively. The type of occlusive lesion encountered, arterial involvement, symptoms, and indications for treatment were noted. Patients were followed and reexamined at six-month intervals and information from this assessment constituted the source of information to determine success and patency rates. Only one patient was lost to follow-up at three months post intervention, at which time the recanalized subclavian artery was patent and the patient was asymptomatic.

RESULTS

There were no operative mortalities or strokes. One patient developed a large cervical wound hematoma which required surgical evacuation. Immediate (technical) success was achieved in 27 arterial segments out of 30 which were approached with intention to treat, for a success rate of 90%. The three immediate failures involved totally occlusive lesions of the left proximal subclavian artery which proved unresponsive to retrograde transluminal recanalization. Long-term arterial patency was achieved in 24 of 30 instances, for a success rate of 80%. The three failure occurred respectively eight (right common carotid artery), 12 (right subclavian artery), and 18 months (left subclavian artery) after the initial procedure, and they all involved restenosis following angioplasty/stenting.

CONCLUSIONS

The retrospective review reported herein demonstrates that angioplasty/stenting of focal stenotic and occlusive lesions of supra-aortic trunks would seem to produce immediate and long-term success rates which are quite acceptable, and may approach those achievable with more conventional surgical reconstruction. Further reporting of larger series of patients followed up for longer periods of time will be necessary for more définitive conclusions regarding these less invasive therapeutic options.