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Percutaneous Transluminal Angioplasty of Supra-aortic
vessels
Amir Motarjeme, MD
Midwest Vascular Institute, Good Samaritan Hospital,
Downers Grove, Illinois, USA
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Purpose:
To retrospectively review the techniques and results
of percutaneous transluminal angioplasty (PTA) in the supra-aortic
vessels.
Methods:
Over a 5-year period, 112 patients underwent percutaneous
treatment of 151 lesions in the innominate, subclavian, carotid,
and vertebral arteries. The percutaneous technique included
standard retrograde femoral artery access in the majority
of patients with balloon dilation of the lesion site. In the
more recently treated patients, stents were deployed for suboptimal
PTA; primary stent deployment was used rarely. Symptom resolution
and > 50% increase in flow were criteria necessary for
a successful procedure.
Results:
In this population, 141 (93%)of151 lesions were successfully
treated. PTA achieved 100% success in stenotic lesions in
the internal (n = 9) and external (n = 2) carotid; common
carotid (n = 8); subclavian (n == 67); and innominate (n =
13) arteries. Ninety-two percent (36/39) of vertebral artery
stenoses were successfully treated. In 13 cases of subclavian
occlusion, however, only 6 (46%) were recanalized. There were
3 periprocedural complications, but only 1 was major; a focal
stroke manifesting as right arm weakness occurred in a patient
with left common carotid PTA and stenting. Five cases of reocclusion
nave been seen in 5 years of follow-up. All occurred in the
subclavian artery, and 3 of the 5 were in arteries originally
occluded.
Conclusions:
Brachiocephalic PTA can achieve excellent immediate and long-term
results in proximal stenoses. Subclavian occlusions do not
respond well to PTA, and those successfully recanalized have
a high restenosis rate (50%). PTA of the arch vessel branches,
particularlythe vertebral artery, should be attempted only
by experienced interventionists. Atherosclerotic lesions in
the internal carotid arteries are best treated with endarterectomy
at present, but fibromuscular dysplasia in the carotid arteries
is an appropriate indication for PTA therapy.
J Endovasc Surg 1996;3:171-181
Key
words: carotid
artery, innominate artery, subclavian artery, vertebral artery,
balloon dilation, stents.
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| Following successful
percutaneous transluminal angioplasty (PTA) of the aortoiliac and renal
arteries, multiple reports of PTA in the vertebral, carotid, innominate,
and subclavian arteries appeared in the radiological literature.1-10
Today, balloon angioplasty and stenting of proximal arch vessel lesions
is considered the treatment of choice by most interventionists.11
Only in the area of the carotid artery does angioplasty remain controversial
because of the fear of cerebral emboli.12
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Now that
stents are available, percutaneous treatment of cervical carotid
artery lesions is undergoing evaluation in severa! clinical
trials.13'14 Given our longstanding
experience with brachiocephalic PTA,3-5,11
we examine the outcomes from more than 100 cases
of arch vessel angioplasty and propose recom-mendations
for patient selection based on this history.
Address for correspondence and reprints:
Amir Motarjeme, MD, 3825 S. Highiand Ave., Tower 2, #306,
Downers Grove, IL 60515. Fax: 708-963-8348.
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