Resolution of ischemic symptoms after percutaneous angioplasty for a symptomatic subclavian artery stenosis

Abstract

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 15years in patients who had undergone successful PTA of SAS. The study group comprised 232 consecutive subjects after successful PTA of SAS (61.9± 8.4years old 53.4% men). The mean follow-up time was 101± 40months (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.