[Balloon dilatation of subclavian artery stenosis and brachiocephalic trunk stenosis]

Abstract

We report our initial experiences concerning percutaneous transluminal angioplasty of four subclavian artery stenoses and one innominate artery stenosis in four patients. In two patients the indication for percutaneous transluminal angioplasty was a severe subclavian steal syndrome, in one patient prophylactic treatment together with carotid endarterectomy before coronary bypass surgery, and in one patient a brainstem infarction. Percutaneous transluminal angioplasty resulted in normal vertebral artery blood flow in all patients and in complete relief of symptoms in the two patients with a subclavian steal syndrome. We experienced no cerebrovascular complications and only one minor peripheral complication. During a follow-up period of seven to 18 months there has been no re-occlusion and no sign of increasing subclavian steal phenomenon. We draw the following conclusions: Selection criteria for percutaneous transluminal angioplasty must be very strict. Doppler sonography before percutaneous transluminal angioplasty is necessary to evaluate the haemodynamic effect of subclavian stenosis upon the vertebral arteries. Doppler sonographic monitoring during percutaneous transluminal angioplasty should be a routine. The risk of cerebral complications is low. Gradual normalisation of vertebral blood flow after percutaneous transluminal angioplasty is common. Percutaneous transluminal angioplasty is judged to be a safe and effective treatment for patients suffering from subclavian steal syndrome.