Subclavian-carotid transposition and subclavian artery stenting for steal-syndrome

Abstract

To analyze in-hospital results of subclavian-carotid transposition and subclavian artery stenting in patients with steal-syndrome. A retrospective open study included 137 patients with occlusion or severe stenosis of the first segment of subclavian artery and steal-syndrome. The 1st group included 50 patients who underwent stenting or recanalization with stenting of the first segment of subclavian artery between January 2010 and March 2020. The 2nd group included 87 patients who underwent subclavian-carotid transposition between January 2010 and March 2020. There were no in-hospital mortality, myocardial infarction, ischemic stroke or bleeding. In the second group, damage to recurrent laryngeal nerve with irreversible laryngeal paresis occurred in 6.9% of patients, and one patient had brachial plexus neuropathy. One patient developed lymphorrhea with chylothorax accompanied by shortness of breath on exertion. Conservative management with repeated pleural punctures was not accompanied by clinical compensation. The patient was discharged for outpatient treatment. Thromboembolism of the left branch of the aorto-femoral prosthesis and deep femoral artery on the left was diagnosed in the endovascular correction group after implantation of Protege GPS stent (10´60 mm) and post-dilation with a PowerFlex PRO balloon catheter (9´4 mm). Acute ischemia of the left lower limb required thrombectomy with patch repair of deep femoral artery. The patient was discharged after 5 days. In another case, vertebral artery dissection occurred after implantation of Protege GPS stent (10×40 mm) and post-dilatation with a PowerFlex PRO balloon catheter (8´20 mm). In this regard, the patient underwent stenting of the fourth segment of vertebral artery (Endeavor Resolute 4.0´24 mm stent) with post-dilation (Boston Scientific Samurai balloon catheter 0.014´190 cm). The patient was discharged after 3 days. Subclavian-carotid transposition and subclavian artery stenting are safe methods of revascularization that are not accompanied by myocardial infarction, ischemic stroke or mortality. However, subclavian-carotid transposition is characterized by higher risk of neurological disorders (laryngeal paresis, phrenic nerve paresis, brachial plexus neuropathy) and wound complications (lymphorrhea, chylothorax). In turn, subclavian artery stenting is associated with the risk of dissection and embolism. Therefore, the choice of treatment strategy in patients with occlusive-stenotic lesions of the first segment of subclavian artery should be personalized and carried out by a multidisciplinary team.