Abstract
BackgroundSubclavian artery stenosis (SAS) is narrowing of the subclavian artery most commonly caused by atherosclerosis. It serves as a marker for cerebrovascular and myocardial ischemic events.MethodsA retrospective cohort study was conducted to determine the association of treatment via combination therapy (antiplatelet drug plus either by-pass surgery or percutaneous transluminal angioplasty (PTA) with or without stent implantation) versus antiplatelet drug therapy alone on cardiovascular events and all-cause mortality in Marshfield Clinic patients diagnosed with symptomatic SAS from January 1, 1995 to December 31, 2009.ResultsOf the total 2153 cases, 100 patients were identified as eligible to be included in the study. Of these 100 patients that met inclusion criteria, 30 underwent combination therapy while 70 were managed only with drug treatment. A median length of follow-up was 8.45 years. Adverse cardiovascular events occurred in 5/30 (17%) of combination therapy patients compared to 28/70 (40%) of antiplatelet drug therapy only patients (p = 0.0355). Accordingly, all-cause mortality was higher (47%) in the antiplatelet drug therapy only group than the combination therapy group (13%) [hazard ratio = 3.45, p = 0.0218].ConclusionsPreliminary findings in this pilot data set suggest that combination therapy (medications plus either surgical or interventional repair) of subclavian artery stenosis is associated with less cardiovascular adverse events and higher survival rates. However, prospective randomized studies with larger number of patients are needed to validate these findings.
Highlights
Subclavian artery stenosis (SAS) is a rare cause of extracranial artery disease with an incidence between 0.6% and 6%
A retrospective cohort study was conducted to determine the association of treatment via combination therapy (antiplatelet drug plus either by-pass surgery or percutaneous transluminal angioplasty (PTA) with or without stent implantation) versus antiplatelet drug therapy alone on cardiovascular events and all-cause mortality in Marshfield Clinic patients diagnosed with symptomatic SAS from January 1, 1995 to December 31, 2009
Adverse cardiovascular events occurred in 5/30 (17%) of combination therapy patients compared to 28/70 (40%) of antiplatelet drug therapy only patients (p = 0.0355)
Summary
Subclavian artery stenosis (SAS) is a rare cause of extracranial artery disease with an incidence between 0.6% and 6%. Diagnosis of hemodynamically significant subclavian artery stenosis requires identifying asymmetrical systolic blood pressure measurements in the upper extremities and ultrasonographic/angiographic evidence of subclavian stenosis and retrograde flow. The threshold for upper extremity systolic blood pressure difference (SBPD) for diagnosis of clinically significant SAS is uncertain. It has been suggested that patients requiring coronary artery bypass grafting (CABG) with an SBPD of at least 10 mm Hg or evidence of peripheral vascular disease (PVD) undergo selective arteriography screening at the time of coronary catheterization [12]. Subclavian artery stenosis (SAS) is narrowing of the subclavian artery most commonly caused by atherosclerosis. It serves as a marker for cerebrovascular and myocardial ischemic events
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