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CLINICAL STUDIES

Percutaneous revascularization of atherosclerotic obstruction of aortic arch vessels

^a Interventional Cardiovascular Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts, USA

Manuscript received July 14, 1998; revised manuscript received November 4, 1998, accepted December 23, 1998.

Reprint requests and correspondence: Dr. Andrew Eisenhauer, Interventional Cardiovascular Medicine, Lahey Clinic Medical Center, 41 Mall Road, Burlington, Massachusetts 01805
Andrew.C.Eisenhauer{at}Lahey.Org

OBJECTIVES

To compare stenting of aortic arch vessel obstruction with surgical therapy and to establish recommendations for treatment.

BACKGROUND

Though surgery has been considered to be the procedure of choice for subclavian and brachiocephalic obstruction, little work has been done to compare it with stenting.

METHODS

Eighteen patients with symptomatic aortic arch vessel stenosis or occlusion were treated with stenting, followed by periodic clinical follow-up and noninvasive arterial Doppler studies. Data were compared with the results as shown in a systematic review of a published series of surgery and stenting procedures which included comparison of technical success, complications, mortality and patency.

RESULTS

Primary success in our series was 100% with improvement in mean stenosis from 84 ± 11% to 1 ± 5% and mean arm systolic blood pressure difference from 44 ± 16 mm Hg to 3 ± 3 mm Hg. There were no major complications (death, stroke, TIA, stent thrombosis or myocardial infarction). At follow-up (mean 17 months), all patients were asymptomatic with 100% primary patency. Literature review demonstrates equivalent patency and complications in the other published series of stenting. In contrast, there was a similar patency but overall incidence of stroke of 3 ± 4% and death of 2 ± 2% in the published surgical series.

CONCLUSIONS

Subclavian or brachiocephalic artery obstruction can be effectively treated by primary stenting or surgery. Comparison of stenting and the surgical experience demonstrates equal effectiveness but fewer complications and suggests that stenting should be considered as first line therapy for subclavian or brachiocephalic obstruction.

Abbreviations and Acronyms   MLD = minimal luminal diameter   RD = reference diameter

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