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. 2022 Nov 17:2022:3249745.
doi: 10.1155/2022/3249745. eCollection 2022.

Association between the Angle of the Left Subclavian Artery and Procedural Time for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

Masatsugu Miyagawa  1 , Daisuke Fukamachi  1 , Katsunori Fukumoto  1 , Masaki Monden  1 , Kurara Takahashi  1 , Shohei Migita  1 , Saki Mizobuchi  1 , Yudai Tanaka  1 , Akihito Ogaku  1 , Yutaka Koyama  1 , Hidesato Fujito  1 , Riku Arai  1 , Norio Takei  1 , Keisuke Kojima  1 , Korehito Iida  1 , Nobuhiro Murata  1 , Yasuo Okumura  1
Affiliations

Association between the Angle of the Left Subclavian Artery and Procedural Time for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

Masatsugu Miyagawa et al. J Interv Cardiol. .

Abstract

Background: The effect of left subclavian artery tortuosity during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains unclear.

Methods: Of 245 ACS patients (from November 2019 and May 2021), 79 who underwent PCI via a left radial approach (LRA) were included. We measured the angle of the left subclavian artery in the coronal view on CT imaging as an indicator of the tortuosity and investigated the association between that angle and the clinical variables and procedural time.

Results: Patients with a left subclavian artery angle of a median of <70 degrees (severe tortuosity) were older (75.4 ± 11.7 vs. 62.9 ± 12.3 years, P < 0.001) and had a higher prevalence of female sex (42.1% vs. 14.6%, P=0.007), hypertension (94.7% vs. 75.6%, P=0.02), and subclavian artery calcification (73.7% vs. 34.2%, P < 0.001) than those with that ≥70 degrees. The left subclavian artery angle correlated negatively with the sheath cannulation to the first balloon time (ρ = -0.51, P < 0.001) and total procedural time (ρ = -0.32, P=0.004). A multiple linear regression analysis revealed that the natural log transformation of the sheath insertion to first balloon time was associated with a subclavian artery angle of <70 degrees (β = 0.45, P < 0.001).

Conclusion: Our study showed that lower left subclavian artery angles as a marker of the tortuosity via the LRA were strongly associated with a longer sheath insertion to balloon time and subsequent entire procedure time during the PCI.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow diagram. CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Representative schematic images (upper panels) and CT images in the coronal view (lower panels) in patients with mild tortuosity (a) and severe tortuosity (b). (a) In a case of mild tortuosity, the angle of the left subclavian artery is 79 degrees. In this case, the time from sheath insertion to the first balloon time was 20 minutes and total procedure time was 46 minutes, respectively. (b) In patients with severe tortuosity, the angle of the left subclavian artery was 55 degrees. In this case, the time from sheath insertion to the first balloon time, the total procedure time, and the fluoroscopy time were longer than in case (a) (43 minutes and 97 minutes, respectively). (c) The angle of the aortic root on the coronal view. The details of the measurement method are shown in the text. LRA, left radial approach; PCI, percutaneous coronary intervention.
Figure 3
Figure 3
Distribution of the angle of the subclavian artery in the coronal view. The median value was 70 (57, 77) degrees, and the mean value was 68 ± 14 degree.
Figure 4
Figure 4
Correlations between the angle of the left subclavian artery in the coronal view and sheath insertion to the first balloon time (a) and total procedural time. (b) The details are shown in the text.
Figure 5
Figure 5
Incidence of contrast-induced nephropathy. Contrast-induced nephropathy occurred more frequently with an angle of the subclavian artery in the coronal view of <70 degrees than of ≥70 degrees (11 patients; 29.0% vs. 2 patients; 4.9%, P=0.005).
See this image and copyright information in PMC

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