Determinants of immediate and long-term results of subclavian and innominate artery angioplasty
Corresponding Author
Tadeusz Przewlocki MD, PHD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Pradnicka 80, 31-202 Krakow, PolandSearch for more papers by this authorAnna Kablak-Ziembicka MD, PHD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorPiotr Pieniazek MD, PHD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorPiotr Musialek MD, PHILD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorAndrzej Kadzielski MSC
Department of Hemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorJaroslaw Zalewski MD
Department of Hemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorArtur Kozanecki MD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorWieslawa Tracz MD, PHD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorCorresponding Author
Tadeusz Przewlocki MD, PHD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Pradnicka 80, 31-202 Krakow, PolandSearch for more papers by this authorAnna Kablak-Ziembicka MD, PHD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorPiotr Pieniazek MD, PHD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorPiotr Musialek MD, PHILD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorAndrzej Kadzielski MSC
Department of Hemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorJaroslaw Zalewski MD
Department of Hemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorArtur Kozanecki MD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorWieslawa Tracz MD, PHD
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Search for more papers by this authorAbstract
Background: Percutaneous angioplasty (PTA) is widely used in the treatment of subclavian/innominate artery obstruction, but factors of long-term PTA outcome are poorly understood. Our aim was to evaluate the efficiency of PTA on symptom resolution and identify determinants of long-term outcome. Methods and Results: Seventy-six lesions were treated in 75 patients (58.7% men) aged 60 ± 8.5 years. PTA was successful in 70 (93.3%) patients, including 58/58 (100%) stenotic lesions and 13/18 (72.2%) occlusions. The mean stenosis grade (QCA) was reduced from 78.9% ± 16.6% to 13.5% ± 10.7% (P < 0.01). A great majority of lesions (87.1%) were stented. In 5 (7.1%) high-risk lesions a proximal or distal neuroprotection system was used. There were no strokes or embolic events. Minor complications occurred in 7 (9.3%) cases. Fifty-seven (89%) of 64 symptomatic patients had complete symptom resolution. The mean follow-up was 24.4 ± 15.5 months (up to 66 months). Ten restenoses (15.6%), including 9 (13.8%) in-stent restenoses and 1 (16.7%) restenosis after balloon angioplasty, were diagnosed in 64 patients and followed up for at least 6 months. Nine symptomatic restenoses were successfully treated with repeated angioplasty. Cox multivariable analysis revealed the following independent predictors of restenosis: implantation of more than one stent (P = 0.005), low stent diameter (P = 0.088), and postprocedural systolic blood pressure difference between upper extremities (P = 0.044). Conclusions: PTA is a safe and effective method for the treatment of the subclavian/innominate artery obstruction and leads to symptom resolution in majority of patients. Restenosis is not frequent and it can be effectively treated with repeat angioplasty. Low stent diameter, implantation of two stents, and upper limb systolic blood pressure difference are independent predictors of restenosis. © 2006 Wiley-Liss, Inc.
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