Percutaneous Transluminal Stent Placement to Treat Subclavian Steal Syndrome

Abstract

To describe nonsurgical stent placement to treat subclavian steal syndrome after failure of traditional balloon angioplasty. Seven patients with subclavian steal syndrome underwent diagnostic angiography, which showed four stenoses and three occlusions of the proximal left subclavian artery. Most patients presented with vertigo, left arm claudication, or syncope. Initial balloon angioplasty failed; there was elastic recoil with more than 30% residual stenosis or subintimal dissection. The three occlusions were treated with urokinase pulse-spray thrombolysis. All seven patients then underwent stent placement. Initial technical success was achieved in all seven cases (100%), with an average right versus left arm blood pressure gradient of 0 mm Hg (-11 to 12 mm Hg) at mean follow-up of 12 months (4-24 months) (positive gradient = systolic pressure of right arm > that of left arm; negative gradient = systolic pressure of left arm > that of right arm). Symptoms of arm claudication and syncope resolved, and vertigo improved or resolved after the procedure. There were no deaths, strokes, or emboli in the perioperative or follow-up period. Percutaneous transluminal stent placement may be an effective treatment of subclavian steal syndrome in patients with lesions that are refractory to traditional angioplasty.