ABSTRACT
<p><b>INTRODUCTION</b>Percutaneous endovascular therapy is an accepted and preferred procedure for symptomatic subclavian artery disease. However, the technical feasibility and effectiveness of treating chronic total occlusion of the subclavian artery with this approach is uncertain. We aimed to evaluate the initial and mid-term results of endovascular therapy for patients with symptomatic chronic total occlusion of the left subclavian artery.</p><p><b>METHODS</b>Consecutive patients who underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery between January 2010 and February 2014 were included.</p><p><b>RESULTS</b>Overall, 16 patients (10 male, 6 female; mean age 56 ± 13 years) underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery. 6 (37.5%) had arm claudication, 8 (50.0%) had vertebrobasilar insufficiency and 2 (12.5%) had coronary steal. 18 balloon-expandable stents were implanted in 15 patients. Central luminal passage was not achieved in one patient because of the subintimal position of the guidewire (procedural success rate 93.8%). There were no procedure-related complications. Mean preprocedural and postprocedural systolic blood pressure differences between the upper extremities were 37 ± 13 (range 25-60) mmHg and 11 ± 9 (range 5-38) mmHg, respectively; the improvement was statistically significant. Outpatient follow-up revealed one asymptomatic restenosis at two years. The patency rate at two years was 93.3%.</p><p><b>CONCLUSION</b>Balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery is safe and effective, with good acute success rate and mid-term patency. Prospective randomised studies on larger patient populations would provide more precise results.</p>
ABSTRACT
To detect the functional importance of coronary collaterals, which develop after acute myocardial infarctions [AMI]. Forty patients with acute AMI whose coronary angiography demonstrated a total occlusion of the left anterior descendant [LAD] artery were included in the study, between January 2003 and June 2004. All of the study patients underwent coronary angiography and left ventriculography using standard Judkins techniques [Phillips Integris-3000]. Left ventricular [LV] free walls were divided into 5 segments, and all of these segments motions were evaluated then LV free wall motion score index [WMSI] was calculated. The study patients were divided into 2 groups: good [Rentrop 3; group I; n = 14] and poor coronary collateral circulation [Rentrop 0-2; group II; n = 26] according to the Rentrop grading. Then, color kinesis dobutamine stress echocardiography [CK-DSE] was performed to all patients with standard techniques 6 weeks after AMI. There were no significant differences for age, gender, risk factors for the coronary artery disease and use of the fibrinolytic therapy between the groups. There were no significant statistical differences for angiographic WMSI, left ventricular ejection fraction [LVEF], end-diastolic volume, end-systolic volume and end-diastolic pressures between the 2 groups. No difference was detected between Group I and II for initial EF, WMSI and peak dose WMSI in CK-DSE procedure. Viability was determined in all of the 14 patients in group I [100%] and 12 of 26 patients in group II [46%] [p=0.03]. In early periods of an AMI genesis of the coronary collateral circulation does not affect left ventricular global and regional systolic functions, but increase viability quite significantly. According to our findings early revascularization could be carried out in patients with good coronary collateral circulation without doing any test for viability